West Palm Beach VA Medical Center Ventilator Associated Pneumonia Best Practices Cindy Lang, RN, BSN, CIC

In ection Control S!ecialist In response to the 100K Lives Campaign the WPB VAMC addressed the VAP Compliance Items within the context o the Critical Care Committee! In addition to ed"cation it was reali#ed that in order to compl$ with the Ventilator B"ndle A"dit Items m"ch disc"ssion and ed"cation was needed! IC% sta mem&ers originall$ '"estioned the rationale or elevation o the (ead o Bed at )* degrees and noted shearing o patients+ s,in! -his in ormation was rela$ed to the VI./ head'"arters and it was agreed that 00 degree elevation was accepta&le! IC% sta mem&ers s"ggested the "se o the .A12 3ral Care Program which was incorporated with 2ver$ ) (o"r 3ral Care! -he .age 3ral Care Kits are h"ng on special hangers &$ each ventilator! .pecial .tr$,er &eds were selected with inp"t &$ IC% n"rses &eca"se the &eds are e'"ipped with digital displa$ o the elevation o 4owler Angle! Previo"sl$ n"rses had to &end over and chec, the elevation angle &$ a man"al ga"ge on the rame o the &ed! .ta mem&ers 56/s and ph$sicians7 were ed"cated on the 100K Campaign and the &"ndle items! 6ein orcement was done dail$ in the IC% Interdisciplinar$ 6o"nds with8 Critical Care Ph$sician 5Intensivist 9 P"lmonologist7 IC% Clinical Pharmacist 5Pharm :; BCP.7 In ection Control Practitioner 5ICP7 6espirator$ -herapist /"rse Case Manager Critical Care Clinical /"rse .pecialist Lead %nit 4acilitator 5IC% Charge /"rse7 .ta 6/s Clinical :ietician .peech Pathologist .t"dents56esidents 9 Interns 9 Pharmac$ 6esidents7 -he In ection Control Practitioner completes the Ventilator B"ndle A"dit 4orm each da$ d"ring morning ro"nds or all patients on mechanical ventilation! -he Lead %nit 4acilitator completes the orm on holida$s and wee,ends! Compliance with each &"ndle items is disc"ssed or each ventilated patient! -he (3B elevation is recorded &$ the ICP! .ta mem&ers addressed the act that radiolog$ technicians wo"ld tend to leave the &ed lat a ter completing a &edside porta&le <=6a$! /ight n"rses have a&andoned the idea that a patient needs to &e la$ing > lat? to sleep! -he Clinical Pharmacist addresses .tress %lcer Proph$laxis and :V- Proph$laxis! .ta mem&ers are '"ic, to point o"t i their patient is lac,ing P%: or :V- proph$laxis in the a&sence o contraindications 5low platelet co"nt; &leeding disorder; etc!7 2ach morning an assessment is made o the patient+s readiness to wean! :ail$ sedation vacations are planned with res"lts doc"mented in the electronic medical record! :ail$ spontaneo"s &reathing trials are per ormed onl$ a ter response to the sedation vacation is

disc"ssed and eval"ated! .ta mem&ers s"ggested a ternoon ro"nds to more closel$ eval"ate weaning trials and readiness! -here ore in addition to the length$ morning ro"nds at @800am each da$ there has &een added a shorter version o ro"nds at 0800pm each da$ or ollow="p and reassessment! 4eed&ac, in terms o compliance with &"ndle items and VAP In ection 6ates has &een provided monthl$ since March A00B! MIC%9CC% and .IC% "nits receive and compare their compliance and in ection rates! -he completed Ventilator B"ndle A"dit 4orms or the wee,ends 5and holida$s7 are given to the In ection Control Practitioner each Monda$ morning d"ring dail$ IC% ro"nds or the next administrative wor, da$ in the case o holida$s! -he attached wor,sheet was developed or reporting &$ the IC% sta to incl"de a report o compliance with the Ventilator B"ndle A"dit Items each da$ d"ring ro"nds8