Achieving Sustained Improvement in Reducing Ventilator Associated Pneumonia

Purpose:
The Durham VAMC recognized an opportunity to improve the ventilator associated pneumonia (VAP) rates in critical care. This initiative began in FY 2009, with the goal of decreasing the current rate, which exceeded both NDNQI and CDC benchmarks for VAP, to a rate more consistent with benchmarks.

Significance:
Ventilator associated pneumonia is a nosocomial pneumonia seen in patients who are mechanically ventilated. It has been associated with relatively high mortality rates, increased hospital stays, and increased costs. In many cases, it can be prevented.

Strategy and Implementation:
Processes were implemented that led to decreased VAP rates and have shown sustained improvement by achieving a VAP rate of 0.0% for FY 11 to date. These impressive results are the outcome of strong interdisciplinary collaboration among Nurses, Physicians, Respiratory Therapists, Infection Control, Logistics, Pharmacy, Informatics, Social Work and Leadership. Project planning began in FY 09 and continued through implementation in FY 10. Multiple evidence based strategies were used to achieve these results: • Implementation of the VAP maintenance bundle • Templated progress notes which acted as an activity checklist • Change in sedation scores to RASS to facilitate weaning • Early extubation when possible • Purchase of specialized endotracheal tubes which allowed continuous aspiration of sub glottic secretions • Purchase of suction regulators for system • Movement of chronic ventilator patients from critical care to long term care facilities

Evaluation:
The innovation proved to be very successful in decreasing VAP. Continued success is measured by ongoing monthly evaluation for VAP, continued evaluation of bundle adherence, with data submission to both NDNQI and the VA In-Patient Evaluation Center (IPEC).

Implications for Practice:
Success of this interdisciplinary approach illustrates the value of strong interdisciplinary collaboration and committed team members in sustaining performance improvements.