Reports: Daily Process, VAE, NHSN

1. Reports: Daily Process, VAE, NHSN Armstrong Institute for Patient Safety and Quality Presented by: Kathleen Speck, MPH Linda Greene, RN, MPS, CIC

2. Armstrong Institute for Patient Safety and Quality

3. Armstrong Institute for Patient Safety and Quality

4. Armstrong Institute for Patient Safety and Quality

5. Armstrong Institute for Patient Safety and Quality

6. Armstrong Institute for Patient Safety and Quality

7. Armstrong Institute for Patient Safety and Quality

8. Armstrong Institute for Patient Safety and Quality

9. Armstrong Institute for Patient Safety and Quality

10. Armstrong Institute for Patient Safety and Quality

11. Armstrong Institute for Patient Safety and Quality

12. Armstrong Institute for Patient Safety and Quality

13. Armstrong Institute for Patient Safety and Quality

14. Armstrong Institute for Patient Safety and Quality

15. Armstrong Institute for Patient Safety and Quality

16. Armstrong Institute for Patient Safety and Quality

17. Armstrong Institute for Patient Safety and Quality

18. Armstrong Institute for Patient Safety and Quality

19. Armstrong Institute for Patient Safety and Quality

20. Armstrong Institute for Patient Safety and Quality

21. Armstrong Institute for Patient Safety and Quality

22. Armstrong Institute for Patient Safety and Quality

23. Armstrong Institute for Patient Safety and Quality

24. Armstrong Institute for Patient Safety and Quality

25. Surveillance Definition Change - VAP to VAE What’s with this VAE Stuff? I don’t get it. Lots of mumbo- jumbo if you ask me

26. http://www.cdc.gov/nhsn/VAE-calculator

27. NHSN Data Total VAE VAC Only IVAC Possible VAP Probable VAP

28. We have the VAE data; now what? • Comparative Data from NHSN • Other Changes ( Combine Possible and Probable VAP) • Device Utilization Ratios

29. In the Meantime Review Outcome Data At the Bedside In Team Meetings

30. Patient Data

31. Looking at the data My first quarter VAC is 15.38 per 1,000 vent days The average performance of the group is 5.5 per 1,000 vent days Do I have opportunities?

32. Looking Carefully at the Measures I notice that my SAT and SBT compliance is much lower than the cohort group. I also notice that subglottic suctioning is lower than the peer group .

33. Looking at Cases • Ms. X is a 26 y.o. vent dependent patient . She has a history anoxic brain injury and is admitted with pneumonia from a long term care facility ( LTCF) • She is placed on antibiotics and after 4 days has stabilized on the vent. She is improving clinically and the plan is to return to the LTCF • On day 7 , she has a significant event and a sustained period of worsening oxygenation. • She meets definition for VAE

34. Case Review • The clinicians have identified that her event was caused by a mucus plug. • What Next?

35. The Analysis • Changes in Nurses and Respiratory Therapy staff- no documentation of secretions • Failure to notice thickened secretions and change in color of secretions • Although Patient was at baseline – did not get her up into a chair • Patient was dehydrated

36. Opportunities • Hardwire ambulation protocols • Assure documentation of secretions • Work collaboratively with respiratory therapy to identify subtle changes • Daily huddle

37. Another Case Mrs. X is a 76 y.o woman admitted to the ICU with septic shock requiring large volume fluid resuscitation. She is intubated and placed on the ventilator She is stable on the ventilator until day 6 when she has progressing oxygenation demands She has developed a VAC

38. Case evaluation No fever No increased white count No new antibiotics Diagnosis: Pulmonary Edema Opportunities for improvement ?

39. Analysis In another ICU, a large proportion of VAC’s are possible or probable pneumonia Evaluation: HOB monitoring? Suctioning frequency? SATs? ET tubes with Subglottic suctioning?

42. Tools

43. The Change Model “If we could change ourselves, the tendencies in the world would also change. As a man changes his own nature, so does the attitude of the world change towards him. … We need not wait to see what others do” -Gandhi

44. Conclusion Analyzing both process and outcome data will lead to new opportunities for improvement VAE gives us an opportunity to take a broader view of patient safety. It’s not about the numbers, it’s about the Patient

45. Next Steps for CUSP • Conduct a culture assessment (HSOPS) • Establish an interdisciplinary CUSP team • Partner with a Senior Executive • Review the Science of Safety training • Identify defects • Download results from your culture assessment (HSOPS) and share with team • Meet regularly with your CUSP team • Use the Daily Goals tool in your ICU

46. Next Steps for Data Collection • Unit Lead completes Structural Assessment • Unit staff complete HSOPS • Unit Lead/Data Facilitator enters Daily Process Measures • Unit staff complete Exposure Receipt Assessment via survey link • Unit Lead/Data Facilitator enters monthly VAE rates • Unit Lead/Data Facilitator enters Early Mobility Measures • Data Facilitator contemplates next steps for collecting Objective Outcomes Measures • Unit Lead/Data Facilitator pulls data reports from the data portal and share the feedback with your frontline staff • One person from unit (we recommend the Unit Lead) complete the Implementation Assessment.

47. Questions Contact the CUSP 4 MVP-VAP Help Desk at cusp4mvp@jhmi.edu for all questions!