VAE PROJECT MASTER ACTION PLAN Note: Please be aware that these areas overlap to reduce duplication and optimize the synergies Practice NHSN Surveillance Data Collection Is VAE NHSN Surveillance data collection taking place in your facility? Yes No One Unit All units Is there data feedback at the unit level? *Use CDC VAE Calculator! http://www.cdc.gov/nhsn/vaecalculator/ Consider automated and/or Multidisciplinary data collection that utilizes Multi-disciplinary team: i.e.-respiratory therapy and nursing. Goals for these new measures: PVAP target should be zero. Identify root causes for events in the other measures within VAE. Elevation of the Head of the Bed (HOB) at Least 30 Degrees Do you monitor this? Is patient/family educated to maintain HOB Elevation? *Consider signage/visual cues, specialized beds, alarms, and other reliability systems to assure compliance.
Peptic Ulcer Disease (PUD) Prophylaxis Do you have ventilator or critical care protocol(s) or standard order(s)? Deep Venous Thrombosis (DVT) Prophylaxis Do you have ventilator or critical care protocol(s) or standard order(s)? Oral Care Protocol Do you have oral care protocols that include at minimum : Interventions every four hours? *Consider pre-packaged daily kits (made internally or through a vendor) *Engage family in assisting with oral care Use of daily chlorhexidine product? Optimal Sedation Management Do you have guidelines on optimal sedation and the Develop protocols medication protocols including frequency, medication dosing, etc.
associated pain management? Does the pharmacist assist with medication management on complex patient prescribed sedation, pain, and other relative drugs to prevent delirium, ADEs, etc. When optimizing the sedation, it is important to consider the medications being used for pain and the drug interactions. *Educate and engage family wherever possible: Discuss timing and potential outcomes of sedation vacation/reduction Patient relaxation techniques Elimination or Reduction in Sedation Do you have protocols or standard order sets for sedation reduction? Is sedation titration protocols managed by RN? Who? Spontaneous Awaking Trial (SAT) Do you do SATs?
Is outcome of SAT Trial communicated to team in coordinating weaning readiness assessment? Is weaning attempted in coordination with the sedation vacation? Is Sedation Vacation/Reduction coordinated with activity and mobility protocols? Advanced Bundle Weaning Protocols Breathing Trials Do you have standardized ventilator weaning protocols? Are the SBT protocols managed *Team coordination for timing of weaning attempt. *Coordination required around Spontaneous Awaking Trial s SATs, reduced sedation and activity and mobility. *Note: many of the same techniques are part of delirium prevention or reduction as well.
Spontaneous Breathing Trial (SBT) by RT? Who? Is SBT Coordinated with Sedation Vacation or SAT? Early Progressive Activity and Mobility Do you have an activity/mobility protocol for all patients on a ventilator? How many disciplines are involved in plan of action for advanced mobility and mobility attempts? Check all that apply: Nursing Physician Physical Therapy Respiratory Therapy Transport/technician Staff *Activity/Mobility process or plan of action should be coordinated with sedation vacation/reduced sedation and weaning attempts. Team discussion around ideal timing, staff presence, equipment needed, etc. is vital Activity/Mobility protocol should go from passive ROM to full ambulation based on patient s condition. Equipment Are circuits changed only when *Some equipment considerations if
Teamwork Systems and Tools necessary? (when visibly contaminated or malfunctioning) Has your facility considered or implemented subglottic suction port endotracheal tubes? Do you have closed ventilator circuit systems that allow for emptying of the water without breaking the circuit? Do you have multidisciplinary rounding or structured communication for ventilated patients? your facility continues to have PVAP when all other interventions are in place such as: Treated endotracheal tubes Subglottic suction port endotracheal tubes *Consider availability of specialized equipment such as: Portable ventilators, Mobility, transfer and transportation aides Educate patient and family about equipment Consider signage and visual cues to assist as reminders and indicators *Recommended rounding/communication with team occur per shift *Include Patient and Family in discussions and daily goals Are daily goals set and discussed? Is Bundle Compliance, SAT, and readiness to wean discussed at a minimum of daily? If not a verbal discussion, is outcome of SAT, SBT, Weaning and activity/mobility attempt(s) readily accessible for provider
Non-Invasive Ventilation (NIV) and all disciplines? Communication vehicle: White Board Bedside Flow Sheet EHR other Do you consider NIV application as an alternative to intubation for some patient conditions? *Use of NIV may avoid mechanical ventilation for some patient conditions *NIV may be used as alternative to reintubation Is NIV used post extubation vs reintubation? Low Tidal Volume Is your hospital exploring the use of low tidal volume ventilator settings in Non-ARDS? *See publications document for research Fluid Management Is your hospital evaluating fluid management protocols in critical care? *See publications document for research Hospital-Acquired Conditions and Infections Delirium Prevention, early identification, and Is assessment and prevention of delirium part of Critical Care Protocols? *Adopt Assessment Protocols *Remember to include non-medication related prevention strategies
management. Is a pharmacist involved in management of medications for those patients at high risk for delirium? Noise Sleep Lighting/darkness *See ICUliberation.org or icudelirium.org tools Prevention of other HAC and HAI Sepsis CAUTI CLABSI Pressure Ulcer Falls C-diff ADE Other: Hospital Specific Aim Do you use Delirium assessment tools? Do you incorporate other prevention practices as able? *No Harm Across the Board Approach