Implementation of the VAP Bundle to reduce hospital acquired VAP

Purpose:
Reduce the incidence of ventilator associated pneumonia (VAP) in the Medical ICU by increasing staff awareness and implemention of the VAP bundle.

Significance:
VAP is a common nosocomial infection in critically ill patients and is associated with poor outcomes, increased length of stay, increased cost and increased mortality. The VAP Bundle is an evidence based practice that is highly effective but often poorly implemented or followed.

Strategy and Implementation:
Implementing a team approach, we increased awareness of the elements of the VAP bundle and monitored the rate of compliance for each element as well as the complete bundle within the medical ICU. Through daily monitoring of each bundle element we were able to identify barriers to compliance and make the appropriate unit and system changes. A key component in monitoring the VAP bundle compliance was the creation of an automated daily audit report by our quality department. The report drew information for each bundle element from the EMR to provide a succinct report for real-time auditing of compliance for each ventilated patient within the medical center. The report replaces a time-consuming process of manual review by nurses who could be otherwise deployed on patient care activities. It is easily accessed and provides a quick view of which bundle elements are missing to allow for earlier reconciliation, improved compliance and documentation to drive improved patient outcomes.

Evaluation:
Through daily monitoring of ventilator care, the medical ICU team was able to increase awareness and improve our VAP bundle compliance from 57% to above 93% compliance leading to zero VAP's over six months.

Implications for Practice:
This experience highlights the prominent role that a sophisticated clinical decision support strategy can play in the identification of opportunities in care.