ICU-CQI prevention of post-operative pneumonia - Safer Healthcare ...
ICU-CQI prevention of post-operative pneumonia - Safer Healthcare ... ICU-CQI prevention of post-operative pneumonia - Safer Healthcare ...
Sir Mortimer B. Davis- Jewish General Hospital ICU-CQI prevention of post-operative pneumonia Paule Bernier, P.Dt.,M.Sc.
- Page 2 and 3: Who what where? • Montréal, Qué
- Page 4 and 5: Aim & Goals • Reduce post-op pneu
- Page 6 and 7: Key Changes Tested • Compliance H
- Page 8 and 9: 100 pneumonia rate vs. compliance t
- Page 10: Conclusions So Far • Keys to Succ
Sir Mortimer B. Davis-<br />
Jewish General Hospital<br />
<strong>ICU</strong>-<strong>CQI</strong> <strong>prevention</strong> <strong>of</strong><br />
<strong>post</strong>-<strong>operative</strong> <strong>pneumonia</strong><br />
Paule Bernier, P.Dt.,M.Sc.
Who what where?<br />
• Montréal, Québec<br />
• 638 beds<br />
• tertiary care teaching hospital<br />
• medical-surgical <strong>ICU</strong><br />
• closed unit<br />
• 22 beds
Team Members<br />
• Nutritionist, <strong>ICU</strong> & Nutrition support<br />
• Intensivist, pneumologist, <strong>ICU</strong> director<br />
• Nurse educator<br />
• Nurse, Clinical research assistant<br />
• Physiotherapist<br />
• Respiratory therapist<br />
•Nurse, IPC
Aim & Goals<br />
• Reduce <strong>post</strong>-op <strong>pneumonia</strong><br />
50% by April 2006<br />
• 90% compliance to <strong>prevention</strong> strategies
PREVENTION BUNDLE<br />
• Head <strong>of</strong> Bed ≥ 30°<br />
• FEEDING TUBES<br />
• SPONTANEOUS BREATHING TRIAL<br />
• EVAC TUBES<br />
• ORAL DECONTAMINATION ♥ SURGERY
Key Changes Tested<br />
• Compliance HOB elevation<br />
• obtain buy-in from nursing and orderlies and all<br />
• <strong>post</strong>ing <strong>of</strong> results and info sheet<br />
• accuracy <strong>of</strong> the displayed angles on beds<br />
• use <strong>of</strong> flow sheet by RT for HOB<br />
• use <strong>of</strong> nurses flow sheet for HOB<br />
• use <strong>of</strong> TF pre-printed orders<br />
• Weaning protocol checklist: format + content<br />
• Manometers: comparison<br />
• Accuracy <strong>of</strong> cuff pressure without manometers<br />
• master the concept <strong>of</strong> PDSA cycle
25<br />
20<br />
15<br />
10<br />
5<br />
0<br />
Pneumonia:<br />
cumulative annual rate per 1000 vent days<br />
21,4<br />
2003-2004 per 6<br />
14,2
100<br />
<strong>pneumonia</strong> rate vs. compliance to<br />
<strong>prevention</strong> bundle<br />
90<br />
80<br />
70<br />
60<br />
50<br />
40<br />
30<br />
20<br />
10<br />
0<br />
82<br />
14,7<br />
79<br />
22,5<br />
100<br />
6,1<br />
1 2 3 4 5 6<br />
financial period 2005<br />
60<br />
11,4<br />
compliance to <strong>prevention</strong> bundle (%) <strong>pneumonia</strong> / 1000 ventilation-days<br />
69<br />
20<br />
89<br />
11,4
Pneumonia:compliance to <strong>prevention</strong> strategies<br />
per financial period<br />
compliance (%)<br />
100<br />
90<br />
80<br />
70<br />
60<br />
50<br />
40<br />
30<br />
20<br />
10<br />
0<br />
1 2 3 4 5 6 7<br />
financial period<br />
bundle Head <strong>of</strong> bed Tube feeding pre-printed orders readiness for extubation
Conclusions So Far<br />
• Keys to Success<br />
– Cohesive team<br />
– One must take on leadership but ownership<br />
must be shared<br />
– Don’t feel threatened by the process (breath<br />
in, breath out…)<br />
– Obtain buy-in from as many people<br />
– Obtain support from superiors<br />
– Should not be perceived as an additional task<br />
– Ongoing process: NOT A PROJECT
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