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Enhancing Patient Care: Strategies Beyond the Bundle for Staff Risk Reduction

This informative session by Daniel J. Barrieau, RRT, CPFT, Director of Respiratory Care Services at Cooley Dickinson Hospital, delves into advanced strategies for reducing risks beyond the standard care bundle. Learn about innovative approaches such as dual-limb heated wire molecular humidity and continuous subglottic suction to prevent ventilator-associated pneumonia. Discover practical measures like using single-use manual resuscitators and implementing a pre-flight checklist for patient transport. Find out how proactive thinking and continuous improvement can lead to significant reductions in VAP rates. Explore successful case studies and valuable insights on improving patient outcomes. 8 Relevant

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Enhancing Patient Care: Strategies Beyond the Bundle for Staff Risk Reduction

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  1. Talking VAP staff identifying risk reduction strategies Daniel J. Barrieau, RRT, CPFT Director of Respiratory Care Services Cooley Dickinson Hospital

  2. What we do beyond the bundle • Dual-limb heated wire molecular humidity • Event related/no change ventilator circuit strategy • Event related/no change closed suction • No in-line nebulizers ~ MDI only

  3. What we do beyond the bundle • Continuous subglottic suction • No break circuit strategy • Single use manual resuscitators (use & toss) • Pre-flight checklist for transport • Strip, clean, replace ~ no reuse

  4. How we got there After bundle implementation, didn’t stop • Knew our CCU was changing • 2005 ~ <150 ventilator days • 2006 ~ planned start of intensivist program

  5. Engaged the Respiratory Therapists • Challenged them to find ways to reduce risk • Philosophy of always asking ‘what else can I do’? • While doing their work ‘keep eyes open’, always look for opportunities • Not reactive, proactive

  6. Do the easy things • Technology is nice, but so is washing your hands ~ zero tolerance • Tie VAP to our actions • Talk about VAP

  7. Talk VAP • Discuss VAP. . .daily • Own it. • Do not believe VAP is inevitable • If it is ok to have some VAP’s how do staff know which ones were ok and which ones weren’t

  8. Can lead to great ideas • Staff looked at intra-hospital transport • Read articles • Thought of as big opportunity • RT noticed, we call ‘time’ on our interventions when we travel

  9. A great and easy idea • Check sheet • Developed by staff RT from talking VAP • All the steps • Finds approximations for our strategies • Home court advantage on the road

  10. Our Opportunities invasive ventilation • FY06 = 147 • FY07 = 649 non-invasive • FY05 = 161 • FY06 = 209 • FY07 = 574

  11. Well. . . • 15 months without VAP • When we had a VAP, we talked about it • Kept looking for risk reduction strategies ~ yep, high risk patients • Vented >19 days each • Transported • Difficult intubations or reintubations

  12. What are we talking about now? Opportunities • Transport • ‘emergencies’ (is it really?) • Difficult airways (aren’t they all?)

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