Linda L. Horton, RN, MSN, CPHQ Mercy Hospital Buffalo January 18, 2012

1. Linda L. Horton, RN, MSN, CPHQ Mercy Hospital Buffalo January 18, 2012

2. Team Composition David Durante, MD Director Critical Care Jarrod Atkinson, RN Nurse Manager ICU Staff nurses Respiratory Therapy Pharmacy Physical Therapy Infection Control Hospitalist Nurse Practitioner Radiology About Us • Mercy Hospital Buffalo Buffalo, New York • 350 bed tertiary care • Regional transfer center

3. Background VAP bundle got us started and progress was made relative to outcomes, but Vent days and use of propofol still exceeded project targets.

4. Changes Made • Actions Taken • physician leader rounding daily ** • education to associates on MAAS scores ** • daily sedation vacations scheduled by the nurse caring for the patient ** • Mobility, dangle, OOB ** • support from interdisciplinary team ** • pharmacy, respiratory therapy, nurses, physicians, physical therapy • VAP bundle re-education • use of ventilator order sheet • HOB elevation – 300 • Implementation of oral care policy & q4h oral care kits • protocol driven sedation tools for propofol (sedation) use • communication • streamline documentation

5. Results Started ICU Expedition

6. Lessons, Challenges and Next Steps • Beyond the Bundle • Pain Management versus Sedation • Staff champions support • Leadership support and visibility with the staff in the unit. Keeping in touch with the front line staff • Case review of events like a root cause - lessons learned, barriers, “old habits” • Daily rounds at the bedside

7. CDC Ventilator Associate Pneumonia IHI Ventilator Bundle APIC Ventilator Pneumonia Prevention Favorite tools/resource to share

8. Questions? Linda L. Horton lhorton@chsbuffalo.org 716-828-2066