VAP: Reduction, Accountability and Commitment

An opportunity was identified to improve the care of the ventilated patient through education and adoption of the Institute for Healthcare Improvement's evidence-based care bundle for the mechanically ventilated patient. A Six Sigma statistical process control chart analysis for VAPs identified a special cause variation in June 2011 that signaled a change in a process and was cause for immediate investigation.

Sources of variation were brainstormed and several issues were immediately identified. Quick fixes implemented included changes in oral care and ventilator products used, implementation of rotational therapy, daily rounding improved nursing documentation compliance of VAP bundle practice, physical changes to ICU rooms and changes in housekeeping and environmental cleaning protocol.

With a renewed culture of accountability and commitment in the VAP prevention, there have been zero VAP incidents in seven months (November 1, 2011–May 31, 2012). Overall compliance with nursing documentation of five key ventilator bundle elements was 59 percent and improved to 90 percent by fourth quarter 2011.

This case study is part of the Illinois Hospital Association's annual quality awards. Each year, IHA recognizes and celebrates the achievements of Illinois hospitals in continually improving and transforming health care in the state. These hospitals are improving health by striving to achieve the Triple Aim--improving the patient experience of care (including quality and satisfaction); improving the health of populations; and reducing the per capita cost of health care.

Award recipients achieve measurable and meaningful progress in providing care that is:

• Safe
• Timely
• Effective
• Efficient
• Equitable
• Patient-centered

(The Institute of Medicine's six aims for improvement.)