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The TEXAS Wake Up and Breathe Quality Improvement Initiative: Data Collection Activities. Terri Conner, PhD Nybeck Analytics Project Manager Texas Wake Up and Breathe Initiative. Overall Initiative Purpose. Improve care for ventilated patients Improve sedative weaning Speed extubation.
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The TEXAS Wake Up and Breathe Quality Improvement Initiative: Data Collection Activities Terri Conner, PhD Nybeck Analytics Project Manager Texas Wake Up and Breathe Initiative
Overall Initiative Purpose • Improve care for ventilated patients • Improve sedative weaning • Speed extubation
Results of Observation Studies Audits from across the country show that • Spontaneous awakening trials (SATs) and Spontaneous breathing trials (SBTs) are only initiated 50% of the time • SBTs not coordinated with SATs
Benefits of coupled SATs and SBTs time on ventilation up to 3 days time in hospital up to 4 days
Texas Wake Up and Breathe Collaborative Structure • Designate champion • Baseline survey • Please complete this at your earliest convenience and return to Terri Conner at terri@nybeck.net • Monthly data submission and surveys • Monthly calls with our group
Three tools • Monthly survey • Daily data collection tool • Monthly data submission
Monthly SurveyAll Teach, All Learn • Aim • Tests conducted • Outcomes • Lessons learned • Barriers / breakthroughs • Plans for next month
Data Collection Efforts • Track performance • Measure impact on outcomes • LOS • Mortality • Antibiotic usage • VAC, IVAC, VAP rates
SAT/SBT Performance Documentation • Clinical champions should oversee SAT/SBT documentation • Integrate into existing processes • Daily care plans • Checklists • Develop your own process
Daily Data Elements Excel spreadsheet tool • Automatic calculation • VAC • IVAC • Possible and probable VAP
Outcome Definitions • VAC • Significant respiratory deterioration after >2 days of stability • IVAC • VAC • abnormal temp or WBC count • >4 days of new antibiotics
Outcome Definitions • Possible VAP • IVAC • Either purulent sputum OR + sputum/BAL culture • Probable VAP • IVAC • Both purulent sputum AND + sputum/BAL culture
Daily Data CollectionIVAC Status • Tmin, Tmax, WBCmin, WBCmax • Enter for a total of 5 days • Start 2 days prior to VAC onset
Daily Data CollectionQAD Determination • QAD • New antibiotic prescribed or continued • Includes days between doses at extended intervals (> q 24 h) • Data are entered for up 10 days (4 days before VAC, on the VAC dx day, and 5 days after VAC)
Daily Data CollectionPossible/Probable VAP Status • Enter sputum/BAL gram stain and culture results • Polys • Epis • Culture • Growth > Threshold
Daily Data CollectionPossible/Probable VAP Status • POLYS • Sputum or BAL gram stain polymorphonucleated cells, neutrophils, or white blood cells • Enter 0 to 4 • 0: none • 1: few, rare, <10 cells/lpf • 2: moderate, >25 cells/lpf • 3: many • 4: abundant
Daily Data CollectionPossible/Probable VAP Status • EPIS • Sputum or BAL gram stain epithelial cells or squamous cells • Enter 0 to 4 • 0: none • 1: few, rare, <10 cells/lpf • 2: moderate, >25 cells/lpf • 3: many • 4: abundant
Daily Data CollectionPossible/Probable VAP Status • CULTURE • Enter the culture result • Growth > Threshold • Yes • > 105 CFU/mL for endotracheal aspirate • > 104 CFU/mL for BAL • > 103 CFU/mL for protected specimen brush • Semi-quantitative equivalents also acceptable
Monthly Data Report • Hospital LOS • ICU LOS • Hospital discharge status • Ventilator days • SAT days – ‘real time’ data collection • SBT days - ‘real time’ data collection • Self-extubated / re-intubated (optional) • Outcomes (VAC,IVAC, poss/prob VAP)
Questions? Repeat webinar on July 16th, 9am CT Please feel free to contact Terri at terri@nybeck.net or Rachel at rhardegree@tha.org
