Transcript Improving Care for Mechanically Ventilated

CUSP 4 MVP – VAP
Improving Care for Mechanically Ventilated Patients
Onboarding 3:
Introduction to Daily Care Process Measures
ARMSTRONG INSTITUTE FOR PATIENT SAFETY AND QUALITY
Johns Hopkins University
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
Polling Question
Who is on the call?
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IP – infection preventionist
RN – registered nurse
RT – respiratory therapist
PT – physical therapist
OT – occupational therapist
MD – physician
Quality improvement professional
Healthcare executive
Educator
Coordinating entity representative
National project team
Other
CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients

Onboarding 3: Daily Care Processes
CUSP 4 MVP - VAP
Comprehensive Unit-based Safety Program
for Mechanically Ventilated Patients and
Ventilator-Associated Pneumonia
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
Today’s Discussion
Sean Berenholtz, MD,
MHS, FCCM
Principal Investigator
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Kathleen Speck, MPH
Brian Boyle
Co-Investigator
Guest Speaker &
International Patient
Safety Advocate
CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Mary Twomley, MS,
PMP
Senior Research
Coordinator II
Onboarding 3: Daily Care Processes
Objectives
• Introduce the Daily Care Process Measures
• Explain Daily Care Process Measures data
elements and their definitions
• Identify strategies for finding the data elements
• Explain importance of spontaneous awakening
trials and spontaneous breathing trials
• Define delirium
• List risks associated with delirium
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
Patient Experience
Brian Boyle
CUSP 4 MVP – VAP
Improving Care for Mechanically Ventilated Patients
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
Introduction to
Daily Care Process Measures
Sean Berenholtz, MD, MHS, FCCM
CUSP 4 MVP – VAP
Improving Care for Mechanically Ventilated Patients
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
Cohort 3 Tracks
CUSP
Daily Care
Processes
Early
Mobility
OR
CHOOSE
ONE
OR
BOTH
LTVV
optional
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
2014 SHEA
Compendium Update1
• Elevate the head of the bed 30-45°
• Provide endotracheal tubes with subglottic
secretion drainage ports for patients likely to
require more than 48 or 72 hours of
intubation
• Manage ventilated patients without
sedatives whenever possible
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
2014 SHEA
Compendium Update1
• Interrupt sedation once a day (spontaneous
awakening trials)
• Assess readiness to extubate once a day
(spontaneous breathing trials)
• Pair spontaneous breathing trials with
spontaneous awakening trials
• Employ early exercise and mobilization
• Use non-invasive positive pressure ventilation
(NIPPV) whenever feasible
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
2013 Society of Critical Care
Medicine PAD Guidelines2
1. Establish an overarching protocolized approach
to daily ICU patient management using 2013
Pain, Agitation, and Delirium (PAD) Guidelines
2. Assess and treat pain first (may be sufficient)
3. If patient remains agitated after adequately
treating pain
– Start with PRN bolus sedation (as needed)
– Use continuous sedation if boluses exceed 3 per hour
4. Avoid benzodiazepines in most patients
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
2013 Society of Critical Care
Medicine PAD Guidelines2
5. Interrupt sedation daily
– If necessary, restart at lowest dose to maintain
chosen target level of consciousness
6. Avoid deep sedation (RASS -4/-5) as it appears
harmful; instead, target awake or alert
7. Screen for delirium (CAM-ICU or ICDSC)
– If delirious, first seek reversible causes and
attempt non-pharmacologic management
8. Use the ABCDE’s to improve outcomes for your
patients
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
Risks Associated with Delirium
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In ICU or hospital–
After discharge–
• Increased mortality
• Longer intubation time
• Average 10 additional days
in hospital
• Higher costs of care
• Increased mortality
• Development of dementia
• Long-term cognitive
impairment
• Requirement for care in
chronic care facility
• Decreased functional
status at 6 months
CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
PAD Treatment of Delirium
Recommendations2
• No published evidence that treatment with
haloperidol reduces the duration of delirium in
adult ICU patients (No Evidence)
• Atypical antipsychotics may reduce the duration of
delirium in adult ICU patients (C)
• Rivastigmine NOT recommended to reduce the
duration of delirium in ICU patients (–1B)
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
Effective Approach to
Delirium Management
• Stop
• THINK
• Last – Medicate
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
“
In God we trust.
All others bring data.
”
– W. E. Deming
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
What Can You Achieve?
SAT Compliance Rate High Performers – Cohort 1
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
VAE Outcomes Incidence Rates
Per 1000 ventilator days – Cohort 1
SAT Compliance Rate High Performers
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
Daily Care Processes
Compliance – Cohort 1
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
Daily Care Processes
Compliance – Cohort 1
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
Daily Care Processes
Compliance – Cohort 2
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
Daily Care Processes
Compliance – Cohort 2
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
VAE per 1000 Ventilator Days –
Cohort 1
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
Sampling
SBT with Seds off Compliance
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
Sampling
Delirium Assessment
Compliance Rate
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
Sampling
% Ventilated Patient Days
without Sedation
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
Sampling
% Achieve RASS/SAS Target
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
Daily Care Processes Data Collection
Kathleen Speck, MPH
CUSP 4 MVP – VAP
Improving Care for Mechanically Ventilated Patients
Daily Care Process Measures
Data Collection Tool
Data
Collection
Tool
Detailed
Instructions
Contraindications & Location Codes
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Onboarding 3: Daily Care Processes
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
Contraindications and
Locations
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
Let’s Begin
Fill Out For All Beds
• Track by bed, not by patient
• Include
– Bed number
– Was the patient in that bed intubated
or trached AND on mechanical
ventilation at the time of observation
• Y = Yes
• N = No
• E = Empty bed
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
Date of Intubation
• Enter the date the patient was
intubated
– If the date is not available*, enter
admission date (either to the unit or
to the hospital, as appropriate)
– If the patient is extubated and reintubated within 24 hours, use the
original date
*i.e., when from an outside institution
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
Sub-G ETT
Does the patient have a subglottic
endotracheal tube?
• Y = Yes
• N = No
– If your unit doesn’t use Sub-G ETTs,
enter N
• C = Contraindicated
– If C, enter the contraindication code
for this patient in the next column
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
Sub-G ETT
Contraindications
• Why a Sub-G ETT is
contraindicated?
• Find the
contraindications on the
back or on page 2 of
the tool
• Remember, enter ‘N’ if
your unit does not use
Sub-G ETTs
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
Location
of Intubation
• Enter the location code where the
patient was intubated
• Find the locations on the back or on
page 2 of the tool
• If you are using Sub-G ETTs on your
unit, but the patient is admitted with a
different type of ETT, this allows you
to track where the patient came from
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
Location
of Intubation
• Where was the
patient
intubated?
• Find the
locations on the
back or on page
2 of the tool
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
Elevating the
Head of Bed
• Is the HOB elevated to an angle of ≥
30° from the horizontal?
– Y = Yes
– N = No
– C = Contraindicated
• If contraindicated, choose the reason
from the contraindications listed on
page 2 of the tool
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
Head of Bed
Contraindications
• Why was placing
the HOB at an
angle of ≥ 30°
from the horizontal
contraindicated?
• Find the
contraindications on
the back or on page
2 of the tool
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
Sedation
Scale
1st question
• What sedation scale do
you use on your unit?
• This question refers to
your unit, not to this
specific patient
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
Sedation
Scale
• R = Richmond Agitation
Sedation Scale (RASS)
• S = Riker SedationAgitation Scale (SAS)
• NU = Unit uses neither
RASS or SAS
– If NU, skip to Delirium
Assessment
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
Sedation
Scale
• Choose either RASS or
SAS, but not both
• Choose the value closest
to 10:00 am
• If equidistant, choose the
earlier time
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
Sedation
Scale: Target RASS
If you use ‘RASS’…
• Target: What is the target RASS
score for this patient?
– Enter RASS sedation scale
value (-5 to 4)
– ‘NS’ means not set
– ‘NK’ means target RASS was
set, but is not known
– Enter ‘NK’ if you don’t know
whether a target RASS was
actually set
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
Sedation
Scale: Actual RASS
If you use ‘RASS’…
• Actual: What is the actual RASS
score for this patient?
– Enter RASS sedation scale
value (-5 to 4)
– Enter ‘X’ if an actual RASS
sedation level was not scored
– Enter ‘NK’ if target RASS was
scored, but is not known
– Enter ‘NK’ if you don’t know
whether a target RASS was
actually scored
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
Sedation
Scale: Target SAS
If you use ‘SAS’…
• Target: What is the target
SAS score for this patient?
– Enter SAS sedation scale value
(1 to 7)
– Enter ‘NS’ if not set
– Enter ‘NK’ if target SAS was set
but is not known
– Enter ‘NK’ if you don’t know
whether a target SAS was
actually set
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
Sedation
Scale: Actual SAS
If you use ‘SAS’…
• Actual: What is the actual SAS
score for this patient?
– Enter SAS sedation scale value
(1 to 7)
– Enter ‘X’ if an actual SAS
sedation level was not scored
– Enter ‘NK’ if target SAS was
scored, but is not known
– Enter ‘NK’ if you don’t know
whether a target SAS was
actually scored
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
Sedation
Scale: NU
If you entered ‘NU’
• NU = Unit uses neither
RASS or SAS
– If NU, skip Target and
Actual sections and go to
Delirium Assessment
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
Delirium Assessment
• C = Confusion
Assessment Method for
the ICU (CAM-ICU)
• A = Attention Screening
Exam (ASE)
• NU = Unit uses neither
CAM-ICU or ASE
– If NU, skip to SAT
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
Attention Screening Exam
(ASE)
• If the CAM-ICU is not yet feasible in your
unit, we recommend that patients at least
undergo the ASE once per nursing shift
• The ASE is feature 2 of the CAM-ICU and
this 10-20 second test of attention is the
cardinal feature of a delirium diagnosis
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
Delirium Assessment
• Choose either CAMICU or ASE, not both
• CAM-ICU incorporates
the ASE
• Choose the value
closest to 10:00 a.m.
• If equidistant, choose
the earlier time
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
Confusion Assessment
Method for the ICU (CAM-ICU)
Society of Critical Care Medicine’s 2013 Pain,
Agitation, and Delirium (PAD) clinical practice
guidelines
• Recommends theses valid and reliable delirium
screening tools
– Confusion Assessment Method for the ICU (CAM-ICU)
– Intensive Care Delirium Screening Checklist (ICDSC)
• Screen moderate to high risk patients at least
once per nursing shift
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
Delirium Assessment
CAM-ICU
Is the patient positive or negative for delirium?
• Enter ‘P’ if the patient is positive for delirium
• Enter ‘N’ if the patient is negative for delirium
• Enter ‘UTA’ if unable to assess
– Such as RASS = -4 or -5 OR SAS = 1 or 2
• Enter ‘X’ if CAM-ICU assessment was not
completed
• Enter ‘NK’ if CAM-ICU was completed,
but results aren’t known
• Enter ‘NK’ if you don’t know whether the
exam was performed
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
Attention Screening Exam
(ASE)
• Determine if patient can follow a simple command
(pay attention) for 10-20 seconds
• Recognize inattention as the cardinal feature of
delirium that must be present for diagnosis
• For centers not using the full CAM-ICU,
conducting the ASE is a good barometer of the
presence or absence of delirium
• May yield abnormal results due to disease, drugs
or other causes
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
Attention Screening Exam
(ASE)
• Provider reads one of the following sequences:
– SAVEAHAART
– CASABLANCA
– ABADBADDAY
• Patient squeezes the provider’s hand when he
hears the letter ‘A’
• Error defined as
– No squeeze with letter ‘A’
– A squeeze on a letter other than ‘A’
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
Attention Screening Exam
(ASE)
• Count the number of errors
• Inattention is present if the patient commits
more than 2 errors
• If the patient squeezes on every letter,
assign an error count of 10
• If the patient doesn’t squeeze on any letter,
assign an error count of 10
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
Attention Screening Exam
(ASE)
What is the patient’s ability to pay
attention?
Use only if CAM-ICU is not performed
• Enter the number of errors, 0 to 10
• Enter ‘UTA’ if unable to assess
– RASS = -4 or -5
– SAS = 1 or 2
• Enter ‘X’ if the exam was not performed
• Enter ‘NK’ if the exam was performed, but
number of errors is not known
• Enter ‘NK’ if you don’t know whether the
exam was performed
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
Spontaneous Awakening Trial
(SAT)
Has the patient had a
Spontaneous Awakening Trial
today?
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
Spontaneous Awakening
Trial (SAT)
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
Spontaneous Awakening
Trial (SAT)
• Enter ‘NS’ if the patient is not sedated
• Enter ‘Y’ if medications for sedation
have been held today
• Enter ‘N’ if medications for sedation
have NOT been held today
• Enter ‘C/NI’ if holding medications for
sedation is either contraindicated or
not indicated today
– If ‘C/NI’ go to next column labeled
“Reason SAT Contraindic”
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
Spontaneous Awakening
Trial (SAT) Contraindications
• Why is an SAT
inappropriate for
this patient?
• Find the
contraindications on
the back or on page
2 of the tool
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
Spontaneous Breathing Trial
(SBT)
Has the patient had a
spontaneous breathing
trial today?
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
Spontaneous Breathing Trial
(SBT)
• Remove ventilator support
• Allow patient to breathe
– With either a T-tube circuit
– Or with a ventilator circuit
– With low levels of PS (5–8 cm H2O in adults)
– With or without 5 cm H2O PEEP
• No changes are required in FiO2 or the level
of PEEP
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
Spontaneous Breathing Trial
(SBT)
• Enter ‘Y’ if the patient had
an SBT
• Enter ‘N’ if the patient did
not have an SBT
• Enter ‘C/NI’ if the use of
an SBT is contraindicated/not indicated
– If ‘C/NI’, go to Reason
SBT Contraindic
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
Spontaneous Breathing
Trials Contraindications (SBT)
• What is the reason
an SBT is
inappropriate for this
patient?
• Find the
contraindications on
the back or on page
2 of the tool
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
Spontaneous Breathing Trial
(SBT) with Sedatives Off
• Was the SBT performed with
the sedatives off?
• Sedatives are considered off:
– During an SAT
– If sedative infusion is stopped
– If standing order for
intermittent sedating meds is
held or cancelled
– If the interval between
standing doses is extended
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
VAE Affinity Group
Tune in to the VAE Affinity Group webinars for Infection Prevention training
on ventilator-associated event surveillance
Webinars are 90 minutes and occur on the fourth Tuesday in September,
October and November at 2:00 PM ET
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DATE
TOPIC
Sept 22, 2015
VAE Surveillance Training: An Overview
Oct 27, 2015
VAE: Infection-related Ventilator-associated
Complication (IVAC)
Nov 24, 2015
VAE: Possible VAP (PVAP)
CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
References
1. Klompas M, Branson R, Eichenwald EC, Greene LR, Howell MD, Lee G, Magill SS,
Maragakis LL, Priebe GP, Speck K, Yokoe DS, Berenholtz SM. Strategies to prevent
ventilator-associated pneumonia in acute care hospitals: 2014 update. Infect Control
Hosp Epidemiol 2014;35(8):915-936. PMID: 25026607.
2. Barr J, Fraser GL, Puntillo K, Ely EW, Gélinas C, Dasta JF, Davidson JE, Devlin JW,
Kress JP, Joffe AM, Coursin DB, Herr DL, Tung A, Robinson BR, Fontaine DK, Ramsay
MA, Riker RR, Sessler CN, Pun B, Skrobik Y, Jaeschke R; American College of Critical
Care Medicine. Clinical practice guidelines for the management of pain, agitation, and
delirium in adult patients in the intensive care unit. Crit Care Med. 2013 Jan;41(1):263306. PMID: 23269131.
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Onboarding 3: Daily Care Processes
Next Steps
Mary Twomley, MS, PMP
CUSP 4 MVP – VAP
Improving Care for Mechanically Ventilated Patients
Invite Your
Hospital Executives
Wednesday, October 14, 2015
2:00 PM – 3:00 PM ET
Executive Engagement
Join Peter J. Pronovost, MD, PhD, FCCM for a
candid discussion on patient safety:
• Role of engaged executives and successful
efforts to improve patient safety
• Business case for patient safety
• Creating an infrastructure to improve
organizational quality
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
A practicing anesthesiologist and critical
care physician, Dr. Pronovost is the
Senior Vice President for Patient Safety
and Quality and Director of the
Armstrong Institute for Patient Safety and
Quality at Johns Hopkins Medicine.
Onboarding 3: Daily Care Processes
Progress List
Enrollment documents due dates
• Letter of Commitment
• Data Use Agreement
• Online Registration
Complete!
Due as soon as possible
Due by August 31st
Choose a track on the online registration form:
• Daily care processes
• Early mobility
• BOTH
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
Next Steps: Homework
• Determine where to find Daily Care Process data
• Determine data collection and upload method for
your unit
• Determine who will collect the data
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
Next Steps:
Homework to Date
Form a CUSP Team on your unit
Schedule meetings through August 2016
Draft a project mission statement
Complete your pre mortem exercise
Educate frontline staff and executive partners on
the science of safety
Administer HSOPS to your unit staff OR Upload
your pre-existing HSOPS data from the last 12
months into the project data portal
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
Mark Your Calendar:
Upcoming Sessions
Tune in to the content webinars for evidence supporting each intervention
Content webinars are 90 minutes and occur at 2:00 PM ET
DATE
TOPIC
Aug 18, 2015
Introduction to Early Mobility:
A Protocol to Get Patients out of the Bed Faster
Aug 25, 2015
Value of Patient and Family Perspective
Engaging Executives and a Business Case for ICU
Quality Improvement
Sept 8, 2015
94
Project Kickoff!
CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
CUSP 4 MVP – VAP Website
Project site will
be password
protected on
Aug 31st , 2015.
Visit:
https://armstrongr
esearch.hopkinsm
edicine.org/cusp4
mvp.aspx
95
CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
What Can I Find on the
CUSP 4 MVP – VAP Website?
• Education materials
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–
–
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Daily Care Toolkits
SAT/SBT Protocol
SAT/SBT Literature Review
SAT/SBT Fast Fact Sheet
• Daily Care Process Data Collection tool
• CUSP Tools and Guides
• Archive of webinars led by subject matter experts
https://armstrongresearch.hopkinsmedicine.org/cusp4mvp.aspx
96
CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes
97
CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Onboarding 3: Daily Care Processes