SPSP Fellowship Project Charter VAP 18.2.11

Document Sample
SPSP Fellowship Project Charter VAP 18.2.11 Powered By Docstoc
					SPSP Fellowship Project Charter

         Norma Beveridge
           February 2011
   Improving the Incidence of VAP
   What are we trying to accomplish ?



Aim: to improve the current incidence of
 Ventilator Associated Pneumonia (VAP) within
 ICU to achieve >300 days between each case
 by December 2011.
                  The rationale

• The ICU implemented the Scottish Intensive Care
  Society Audit Group VAP prevention bundle in
  September 2008 and has a recorded sustained
  compliance with this >95% however the incidence of
  VAP has remained relatively unchanged.
• In the last 12months there have been 13 reported cases
  of VAP within ICU or an average over the 12 month
  period of 8VAP/1000 ventilator days.
• The longest time period to date between infections is
  125 days with last recorded infection being 23.10.11
 How will we know that change is an
           improvement?
Outcome measures
• Reduced rate of VAP infection on ICU
• Days between VAP infection
• Reduced average length of stay on ventilation
• Reduced average length of stay on ICU



Process measures
• % Compliance with SICSAG VAP prevention bundle from ward
   watcher data collection and actual by sampling
• % of patients with robust , realistic ventilation weaning goals
   documented and reviewed
 How will we know that change is an
           improvement?

Process measures continued
• % of eligible patient who have a sedation hold carried
  out
• Staff evaluation of their understanding of the purpose of
  the VAP prevention bundle

Balancing measures
• Re intubation rate
• Readmission rate to ICU
                 ICU , Queen Margaret Hospital VAP Rate



                                                      September    2 VAP
                                                      October      2 VAP
                                                      November     3 VAP
                                                      January     1VAP
                                                      February    4 VAP
                                                      March       2 VAP
                                                      April       2 VAP
                                                      May          0 VAP
                                                      June        0 VAP
                                                      July        2 VAP
                                                      August      1VAP
                                                      October     1 VAP
                                                      November     0 VAP
                                                      December     0VAP
                         VAP Rate                     January      0 VAP
The total number of VAP in a month divided by total
number of ventilator days for the month X by 1000
                 ICU , Queen Margaret Hospital
                 ALOS on Mechanical Ventilation

                                                May /June 09 – 2 long term
                                                ventilated patients in unit

                                                October 09 – occupancy 99%
                                                Ventilator days up

                                                December 09 & January 10
                                                4 patients on continuous
                                                ventilation

                                                February 10 3 very long term
                                                ventilated patients

                         Shift in data          May /June 10 –1long term
                                                ventilated patient in unit




Total number of ventilator days for the month
Total number of patients ventilated for the month
ICU , Queen Margaret Hospital
           ALOS
                                                 May /June 09 – 2 long term
                                                 ventilated patients in unit

                                                 October 09 – occupancy 99%


                                                 December 09 & January 10
                                                 4 patients on continuous
                                                 ventilation

                                                 February 10 3 patients on
                                                 continuous ventilation

                                                 May/June 10 1 long stay
                                                 patient in unit




                                       ALOS
                 Total patient days for the month
      divided by Total number of patients discharged in the month
What changes can we make that will
      result in improvement?
  Following a review of current practice we will
  focus on 2 elements of the SICSAG VAP
  bundle:
• 1. Sedation will be reviewed, and if appropriate,
  stopped each day
• 2. All ventilated patients will be assessed for
  weaning and possible extubation each day
   Interventions: What changes can we
   make that will result in improvement?
• Develop and implement sedation hold guidance for the bedside
  nurse.
• Review the current daily progress sheet used on the ward round to
  include specific daily weaning goal(s) and an evaluation of
  progress.
• Review ten sets of patient notes weekly to look at actual
  compliance with the VAP bundle compared to documented
  compliance.
• Carry out a case note review of VAP infections in the previous 12
  months (January 2010 – January 2011) to identify any recurrent
  themes that may provide additional learning for the team.
• Re launch nursing education on the VAP bundle
                   Benefits

• Patients: reduced morbidity and mortality
  associated with VAP
• Staff: improve on the quality of care delivered
• The organisation: reduction in costs
  associated with hospital acquired infection and
  including costs associated with antimicrobials
  and the increased length of stay as a result of
  the infection.
              Team membership
• Norma Beveridge, Clinical Nurse Manager for critical
  care
• Anne Mackinnon, Risk Management Co-ordinator
• Duncan Ford Senior, Staff Nurse ICU
• Donna Beattie, Staff Nurse ICU
• Dr Martin Clark, Consultant Intensivist
• Julie Taylor Staff Nurse ICU and ICU SICSAG Local
  Area Co-ordinator
• Callum Fitzwater Staff Nurse ICU

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:3
posted:10/24/2012
language:English
pages:12