Use of ICU Ventilator Bundles

The Problem

OSF St. Mary Medical Center, in collaboration with the OSF system-wide Patient Safety Collaborative and the Institute for Healthcare Improvement, implemented ventilator bundles in its ICU to improve care and outcomes for patients on mechanical ventilation. After reviewing current literature, the hospital developed a protocol unique to its facility to successfully reduce the number ventilator-associated pneumonia episodes, average number of days patients are on the ventilator, and ICU length of stay. In the past 20 months, SMMC has not experienced one VAP, average number days patients are on the ventilator has decreased by 1.8 days, and ICU length of stay has decreased by 1.12 days.

The Solution

After learning of others'success in improving the care of ICU patients on mechanical ventilation though the use of ventilator bundles, OSF St. Mary Medical Center decided to implement a similar activity aimed at improving the care of its own patients. The hospital began the initiative by conducting a literature review for evidence-based practice regarding the care of ventilator patients. After reviewing quality improvement articles and presentations about successful implementation, the patient safety officer, ICU charge nurse, and respiratory therapy staff determined the components for SMMC's bundle, developed a ventilator bundle protocol for ICU and Respiratory use, and conducted trainings for staff in both departments, educating them about the protocol and interventions that were to be followed. The team also developed an audit tool to collect the data on an ongoing basis. Successful implementation of ICU ventilator bundles required acceptance and ownership of the project by both the ICU and Respiratory Therapy departments. Working as a single team, the two departments have improved the care and outcomes of ICU patients on mechanical ventilation. Additionally, the activity required heavy physician involvement to change the routine ventilator orders to include the identified bundle components. For example, physicians have begun to routinely order PUD prophylaxis and have changed their sedation medications to achieve a lower Ramsey score of 3 or 4.

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