What’s New in the Patient Safety World
July 2017
Multi-State VAP Collaborative Successful
A Johns Hopkins-led collaborative
project involving 56 ICUs at 38 hospitals in Maryland and Pennsylvania from
October 2012 to March 2015 successfully reduced rates of ventilator-associated
events (Rawat
2017). The quarterly
mean ventilator-associated event rate significantly decreased from 7.34 to 4.58
cases per 1,000 ventilator-days after 24 months of implementation, a 38%
reduction. Infection-related ventilator-associated complications decreased from
3.15 to 1.56 per 1,000 ventilator-days. Even more impressive was the reduction
in rates of possible and probable ventilator-associated pneumonia, which
decreased from 1.41 to 0.31 cases per 1,000 ventilator-days, a 78% reduction.
Like many of the
collaborative projects led by Johns Hopkins clinicians and researchers,
training related to unit teamwork and safety culture was a key. Principles of
CUSP (Comprehensive Unit-based Safety Program) are a core element (see our
March 2011 What's New in the Patient Safety World column “Michigan
ICU Collaborative Wins Big” for comments about CUSP and links to
resources).
The training
emphasized evidence-based practices:
- head-of-bed elevation
- use of subglottic secretion drainage endotracheal tubes
- oral care
- chlorhexidine mouth care
- daily spontaneous
awakening and breathing trials
The above collaborative was sponsored by AHRQ, NIH and several other organizations. Another collaborative of hospitals in the Hospital Innovation and Improvement Network (HIIN) project led by the Centers for Medicare & Medicaid Services (CMS) and the Partnership for Patients (PFP) used the HRET Preventing Ventilator-Associated Events Change Package (HRET 2017). That describes how the elements of the ABCDEF Bundle (see our September 20, 2016 Patient Safety Tip of the Week “Downloadable ABCDEF Bundle Toolkits for Delirium”) can be implemented and reduce the rate of ventilator-associated events.
Collaboratives which promote adherence to evidence-based interventions have usually demonstrated successful outcomes. However, the core elements of CUSP and culture training are critical to the success of such collaboratives. We always tell hospitals that patient safety projects are much more likely to be successful when implemented at the unit level than across entire institutions.
References:
Rawat N, Yang T, Ali, KJ, et al. Two-State Collaborative Study of a Multifaceted Intervention to Decrease Ventilator-Associated Events. Critical Care Medicine 2017; Published Ahead of Print Post Author Corrections: April 26, 2017
HRET (Health Research & Educational Trust). Preventing Ventilator-Associated Events Change Package. Update 2017
http://www.hret-hiin.org/Resources/vae/17/HRETHIIN_VAE_ChangePackage_508.pdf
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