cusp for vap: year in review
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© The Johns Hopkins University and The Johns Hopkins Health System Corporation, 2011
CUSP for VAP: Year in Review
Sean Berenholtz, MD, MHS
Kathleen Speck, MPH
The Armstrong Institute for Patient Safety and Quality
February 6, 2014
CUSP for VAP: Project Review
• NIH/NHLBI and AHRQ funded project
– Individual hospitals participate for 3 years, including 2 year
intervention period and 1 year sustainability period
• Leveraging leaders in field
– Armstrong Institute for Patient Safety and Quality, NIH/NHLBI, CDC,
AHRQ, University of Pennsylvania
– Maryland Hospital Association
– Hospital and Healthsystem Association of Pennsylvania
2
Project Goals
• Our objectives were:
– To achieve significant reductions in VAE rates
– To achieve significant improvements in safety culture utilizing the
components of CUSP
– To advance the science of VAP prevention utilizing:
- Updated VAP prevention bundle
- New CDC NHSN VAP definition
- Identification of contextual variables that foster/impede the
implementation of QI projects
3
• Key concepts: Adaptive and Technical Work
How Will We Get There?
4
Why Safety Culture Matters?
1. Safety culture is related to outcomes
– Patient outcomes• Patient care experience
• Infection rates, sepsis
• Postop. hemorrhage, respiratory failure, accidental puncture/laceration
• Treatment errors
– Clinician outcomes• Incident reporting, burnout, turnover
5
Huang et al., 2010; Mardon et al., 2010; MacDavitt et al., 2007; Singer et al., 2009; Sorra et al., 2012; Weaver, 2011.
Why Safety Culture Matters?
2. Safety culture influences the effectiveness of other safety and quality interventions
– Can enhance or inhibit effects of other interventions
3. Safety culture can change through intervention
– Best evidence so far for culture interventions that use multiple components
6Haynes et al., 2011; Morello et al., 2012; Van Nord et al., 2010; Weaver et al., in press
Technical Work
• Project currently in 2nd year of implementation phase
• We have introduced the following VAP prevention measures to reduce VAE rates:
- Process Measures • HOB• Sub-G ETT• Oral care• Oral care with CHG• SAT
• SBT
- Early Mobility
7
Adaptive Work
• We have introduced the following CUSP tools:
- CUSP Components• Science of Safety
• Learning from Defects
• Engaging Senior Executives & Leadership
• Daily Goals
• Culture Checkup
• Shadowing
• Daily Briefing
• Barrier identification and Mitigation
8
Project Resources
• VAP Tools– https://armstrongresearch.hopkinsmedicine.org/vap/
vap/resources.aspx
• CUSP Tools– https://armstrongresearch.hopkinsmedicine.org/vap/
cusp/resources.aspx
• Recordings and Slide Presentations for CUSP and VAP Webinars– https://armstrongresearch.hopkinsmedicine.org/vap/
calls.aspx
9
MD and PA Teams Are Engaged: MedConcert
Teams have shared tools and protocols via MedConcert:•Holy Cross Hospital MICU – Noon Charge Nurse Update Protocol
•University of Maryland Shore Health Hospitals - ABCDE Protocol
•Johns Hopkins Hospital WICU – VAP Family Involvement Sign-In Protocol
•Western Maryland Health System – Vent Weaning Protocol
•Meritus Medical Center – Vent Weaning Pocket Protocol
•St. Agnes Hospital – Flow Sheet, Mechanical Vent Weaning Protocol, Mechanical Vent
Management Protocol, Drug Administration Protocol
•Maryland Hospital Association - VAP Talking Points Document
MedConcert Link:•https://www.medconcert.com/
10
MD and PA Teams Are Engaged:Content/Coaching Call Participation
Teams have presented their experiences on CUSP/VAP content/coaching calls:
•St. Agnes Hospital AICU - Early Mobility
•Magee Rehabilitation Hospital SCI - Early Mobility
•Troy Hospital ICU – Early Mobility
•Johns Hopkins Hospital WICU – Learning from Defects
•Prince George’s Hospital ICU – PreMortem
•Johns Hopkins Bayview Medical Center MICU – PreMortem
•Sinai Hospital of Baltimore ICU - PreMortem
11
MD and PA Teams Are Engaged:Exposure Receipt Assessment Pilot
Teams have helped to pilot the Exposure Receipt Assessment and provided feedback:
•Western Maryland Health System CVU and ICU
•MedStar St. Mary's Hospital ICU
•Meritus Medical Center CCU
•Doylestown Hospital ICU
•St Joseph's Hospital ICU
•Brandywine Hospital ICU
12
MD and PA Teams Are Engaged:Early Mobility
Helped to develop the Early Mobility Data Collection Instrument
•St. Agnes Hospital AICU
•Magee Rehabilitation Hospital SCI
•Troy Hospital ICU
Helped to pilot the Early Mobility Data Collection Instrument
•Johns Hopkins Hospital WICU, SICU, CVSICU
13
MD and PA Teams Are Engaged:Video Submissions
• Teams have shared stories via video submissions:
14
© The Johns Hopkins University and The Johns Hopkins Health System Corporation, 2011
Reports: 2013 – A Year in Review
REPORTS
• Report highlights from of several assessments in 2013:
i. Summary Reports (Process Measure Data)
ii. VAE Rates
iii. Structural Assessment
iv. Exposure Receipt Assessment – Pilot
v. Quarterly Interviews
16
Compliance Reports: VAP Daily Process Measures (Q1-Q3 2013)
Compliance Rates - Aggregated
Q1 2013 Q2 2013 Q3 2013 P-value*(Q1 vs. Q3)
Data Entry Completion Rate
70% 71% 70% -
HOB
97%(13783/14201)
98%(12569/12834)
99%(7615/7711)
<0.001
Sub-G ETT30%
(527/1762)39%
(624/1604)38%
(320/845)<0.001
Oral Care67%
(9352/14006)71%
(8774/12388)76%
(5076/6664)<0.001
Oral Care with CHG
81%(10623/13097)
86%(10109/11720)
83%(5306/6398)
0.002
SAT74%
(6566/8815)76%
(6287/8227)78%
(3467/4436)<0.001
SBT67%
(6227/9243)74%
(5690/8067)70%
(3056/4341)<0.001
17
* The P-value was obtained by performing a Fisher’s Exact Test.
Table 1: Compliance Report for Daily Process Measures
Completion Rates: VAP Daily Process Measures (Q1- Q3 2013)
18
Hospital/Unit Jan 2013 Feb 2013 Mar 2013 Apr 2013 May 2013 Jun 2013 Jul 2013 Aug 2013 Sep 2013 Oct 2013 Nov 2013 Dec 2013 Jan 2014Anne Arundel Medical Center - Critical Care Unit 0 % 0 % 0 % 0 % 0 % 0 % 0 % 0 % 0 % 0 % 0 % 0 % 0 %
Bon Secours Baltimore Health System - ICU 6 5 % 3 9 % 8 1 % 8 0 % 9 0 % 1 0 0 % 8 4 % 7 4 % 9 3 % 9 4 % 8 7 % 5 5 % 0 %
Dorchester General Hospital - ICU 0 % 0 % 0 % 0 % 0 % 0 % 0 % 0 % 0 % 0 % 0 % 0 % 0 %
Holy Cross Hospital - CCU 8 4 % 8 9 % 9 7 % 9 7 % 1 0 0 % 1 0 0 % 9 7 % 9 4 % 5 3 % 0 % 0 % 0 % 0 %
Holy Cross Hospital - ICU 7 1 % 8 6 % 8 7 % 8 0 % 8 1 % 1 0 0 % 9 4 % 9 4 % 5 3 % 0 % 0 % 0 % 0 %
Holy Cross Hospital - SICU 6 % 9 6 % 9 4 % 8 3 % 8 1 % 8 7 % 8 1 % 7 7 % 8 3 % 0 % 0 % 0 % 0 %
Howard County General Hospital - Intensive Care Unit 6 5 % 6 4 % 7 1 % 9 3 % 8 7 % 7 7 % 7 4 % 6 1 % 8 3 % 8 7 % 8 3 % 8 1 % 2 9 %
Johns Hopkins Bayview Medical Center - CICU 8 4 % 1 0 0 % 1 0 0 % 1 0 0 % 9 0 % 1 0 0 % 9 0 % 1 0 0 % 2 7 % 0 % 0 % 0 % 0 %
Johns Hopkins Bayview Medical Center - MICU 1 0 0 % 1 0 0 % 9 0 % 9 7 % 9 0 % 1 0 0 % 8 4 % 1 0 0 % 1 7 % 0 % 0 % 0 % 0 %
Johns Hopkins Hospital & Health System - CVSICU 1 0 0 % 8 9 % 8 7 % 1 0 0 % 1 0 0 % 9 7 % 1 0 0 % 1 0 0 % 1 0 0 % 9 0 % 5 3 % 4 5 % 0 %
Johns Hopkins Hospital & Health System - NCCU 1 0 % 4 3 % 1 0 % 0 % 0 % 1 7 % 1 3 % 1 6 % 3 7 % 0 % 0 % 0 % 1 0 %
Johns Hopkins Hospital & Health System - SICU 4 8 % 5 4 % 4 5 % 4 3 % 6 8 % 6 3 % 7 1 % 3 9 % 5 3 % 4 5 % 3 3 % 3 2 % 6 %
Johns Hopkins Hospital & Health System - WICU 8 4 % 8 6 % 9 0 % 9 3 % 9 0 % 8 7 % 9 0 % 9 4 % 8 0 % 2 6 % 0 % 0 % 0 %
Laurel Regional Hospital - 4B Spellman Specialty 6 5 % 6 8 % 5 5 % 1 3 % 6 % 3 % 1 0 % 1 6 % 3 0 % 0 % 0 % 0 % 0 %
Laurel Regional Hospital - Intensive Care Unit 9 0 % 9 6 % 4 2 % 0 % 0 % 0 % 1 9 % 1 0 0 % 0 % 0 % 0 % 0 % 0 %
MedStar Franklin Square Medical Center - ICU 1 0 % 4 6 % 2 3 % 0 % 0 % 0 % 0 % 0 % 0 % 0 % 0 % 0 % 0 %
MedStar St. Mary's Hospital - ICU 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 6 5 %
MedStar Union Memorial Hospital - CCU 1 0 0 % 1 0 0 % 9 7 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 7 7 % 8 3 % 1 0 0 % 1 3 %
Meritus Medical Center - 4 West Critical Care 1 0 0 % 1 0 0 % 1 0 0 % 9 7 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 2 6 %
Prince George's Hospital Center - ICU 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 6 3 % 3 2 % 1 0 0 % 1 0 0 % 2 9 % 0 % 0 % 0 %
Saint Agnes Hospital - AICU 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 0 % 0 % 0 % 0 %
Sinai Hospital of Baltimore - 4th Floor ICU 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 9 3 % 1 0 0 % 1 0 0 % 1 0 0 % 7 1 %
Suburban Hospital - ICU 3400 9 7 % 9 6 % 1 0 0 % 8 0 % 8 7 % 1 0 0 % 9 7 % 1 0 0 % 1 0 0 % 6 8 % 0 % 0 % 0 %
Suburban Hospital - ICUA 3100 8 1 % 1 0 0 % 4 2 % 3 0 % 7 7 % 4 3 % 9 7 % 9 4 % 9 7 % 2 3 % 0 % 0 % 0 %
Abington Memorial Hospital - 3T1&2 0 % 1 0 0 % 1 0 0 % 9 3 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 6 1 %
Abington Memorial Hospital - 3T3&4 0 % 9 3 % 9 7 % 9 3 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 6 1 %
Abington Memorial Hospital - MICU 0 % 9 6 % 9 7 % 8 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 9 7 % 6 1 %
Abington Memorial Hospital - WPCU/1W 0 % 9 6 % 1 0 0 % 9 3 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 9 0 % 1 0 0 % 1 0 0 % 8 4 % 6 1 %
Brandywine Hospital - ICU 1 8 % 5 2 % 0 % 0 % 0 % 0 % 0 % 0 % 0 % 0 % 0 % 0 %
Doylestown Hospital - ICU 3 % 3 2 % 3 5 % 1 0 % 0 % 0 % 0 % 3 % 0 % 1 9 % 3 % 0 % 0 %
Indiana Regional - ICU 0 % 0 % 0 % 0 % 0 % 1 0 0 % 1 0 0 % 9 4 % 8 3 % 0 % 0 % 0 % 0 %
Lower Bucks Hospital - ICU 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 0 %
Magee Rehabilitation - SCI 1 0 0 % 1 0 0 % 3 9 % 1 0 0 % 8 4 % 9 3 % 9 4 % 1 0 0 % 1 0 0 % 0 % 0 % 0 % 3 9 %
NPHS- St Josephs- ICU 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 9 7 % 9 7 % 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 6 %
NPHS- St Josephs- PICU 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 2 7 % 1 0 0 % 1 0 0 % 0 % 1 0 0 % 1 0 0 % 1 0 0 % 0 %
Troy - ICU Med/surg 0 % 0 % 6 5 % 6 3 % 6 8 % 8 0 % 1 0 0 % 1 0 0 % 1 0 0 % 9 0 % 1 0 0 % 9 0 % 0 %
Table 2: Completion Rates on Daily Process Measure Data Entry
Break from data collection
VAE Rates: VAC (Q2-Q4 2013)
19Figure 1 & Table 3: VAC Rate Per 1000 Ventilator Days
Q2 2013 Q3 2013 Q4 2013 P-value*(Q2 vs. Q4)
Aggregate 4.26 (77/18077)
4.74 (61/12871)
2.72 (16/5890)
0.116
MD 3.51 (40/11387)
5.56 (49/8810)
2.85 (12/4208)
0.639
PA 5.53 (37/6690)
2.95 (12/4061)
2.38 (4/1682)
0.118
Per 1000 Vent Days
VAE Rates: IVAC (Q2-Q4 2013)
20Figure 2 & Table 4: Total IVAC Rate Per 1000 Ventilator Days
Q2 2013 Q3 2013 Q4 2013 P-value*(Q2 vs. Q4)
Aggregate 3.04(55/18077)
3.26 (42/12871)
1.53 (9/5890)
0.058
MD 3.25(37/11387)
3.18(28/8810)
1.19 (5/4208)
0.035
PA 2.69 (18/6690)
3.45 (14/4061)
2.38 (4/1682)
1.000
VAE Rates: VAP [PoVAP + PrVAP]
(Q2-Q4 2013)
21Figure 3 &Table 5: Total VAP Rate Per 1000 Ventilator Days
Q2 2013 Q3 2013 Q4 2013 P-value*(Q2 vs. Q4)
Aggregate 1.38(25/18077)
1.40 (18/12871)
0.68 (4/5890)
0.202
MD 1.49(17/11387)
1.36(12/8810)
0.48 (2/4208)
0.125
PA 1.20 (8/6690)
1.48 (6/4061)
1.19 (2/1682)
1.000
Completion Rate: VAE Rate Registry Data (Q2–Q4 2013)
22
Q2 2013 Q3 2013 Q4 2013
Aggregate 100% 88% 53%
MD 100% 86% 54%
PA 100% 90% 51%
Proportion of months with VAE data
Figure 4 & Table 6 : Total VAP Rate Per 1000 Ventilator Days
Structural Assessment: Oct. 2012 – Jan. 2013 (n=36)
Baseline •MD = 21 units (58.3%) •PA = 15 units (41.7%)
Results Reported•31.4% changing their ventilator circuits routinely
•60% changing their suctioning systems routinely
•85.3% used the orotracheal route for elective intubation in absence of difficult airway
•85.3% used a closed suction system with endotracheal tubes
•97.1% have policies for using precautions when suctioning, with 88.9% using these elements
•91.2% have policies for using hand hygiene, with 86.1% using these elements
23
Structural Assessment: Oct. 2012 – Jan. 2013 (n=36)
Results Reported•13.9% used prophylactic IV antibiotics for VAP
•70.6% used policies against non-essential tracheal suctioning, with 16.7% using these elements
•94.1% used policies against supine positioning, with 16.7% using these elements
•67.7% have policies against gastric over-distention, with 0% occurrence
•71.9% had policies regarding performing condensate draining, with 41.7% using these elements
•57.1% used noninvasive ventilation, 44.1% had policies promoting its use
•33.3% used early mobility, 41.2% had policies promoting its use
24
Exposure Receipt Assessment Pilot
25
• Evaluates the penetrance of the CUSP and VAP interventions to front-line staff
• Anonymous assessment
• Completed by staff with direct patient care on the unit for only one shift
• Piloted by 5 teams in MD and PA
• Results divided into 4 domains:1. Response Rate on Assessment2. Distribution of Participants3. CUSP Components4. VAP Components
Exposure Receipt Assessment Pilot: Familiarity with CUSP Components (Nov. 2013)
26Figure 5: Reported Familiarity with CUSP Components of Intervention
Exposure Receipt Assessment Pilot: Training on VAP Toolkit (Nov. 2013)
27Figure 6: Reported Training on VAP Prevention Toolkit in Unit
Quarterly Interviews:Frequent Barriers to Progress (Q1 2013)
28
Table 7. Barriers Reported as Being Frequent or Always
All units (N=43) MD units (N=23) PA units (N=20)
Barrier Percent of Units Barrier Percent
of Units Barrier Percent of Units
Competing priorities 58.1 Competing priorities 47.8 Competing priorities 70.0
Data collection burden 48.8 Data collection burden 43.5 Data collection burden 55.0
Not enough time 39.5 Not enough time 39.1 Staff turnover on unit 45.0
Data system problems 32.6 Data system problems 26.1 Confusion on CUSP 40.0
Staff turnover on unit 27.9 Leader support - exec 13.0 Not enough time 40.0
Leader support - MDs 18.6 Leader support - MDs 13.0 Data system problems 40.0
Confusion on CUSP 18.6 Staff turnover on unit 13.0 Leader support - MDs 25.0
Poor buy-in - MD staff 16.3 Knowledge of evidence 8.7 Turnover CUSP team 25.0
Turnover CUSP team 14.0 Poor buy-in - MD staff 8.7 Poor buy-in - MD staff 25.0
REPORTS SUMMARY 2013
• Highlights from of several assessments – including Summary Reports (Process Measure Data), VAE Rates,
Structural Assessment, Exposure Receipt Assessment Pilot, Quarterly Interviews
• Your Unit’s reports are available on CECity platform
• Can be utilized for- Increasing communication with your team members and front-line staff- Illustrating your unit’s progress to your senior executive partner- Sharing your performance and progress on VAE prevention with your
hospital administrators
29
© The Johns Hopkins University and The Johns Hopkins Health System Corporation, 2011
Your work makes a difference!
CUSP4MVP-VAP National Project Overview
MD and PA Work Influenced the CUSP4MVP-VAP National Project
• Based on your feedback
– Changing approach for incorporating CUSP into our QI
project
– Revising tools (i.e. quarterly interview, early mobility pilot,
exposure receipt assessment pilot)
– Including objective outcome measures
– Focus on sedation and delirium management
31
CUSP4MVP-VAP: Participating CEs
• Coordinating Entities (CEs) for Cohort 1 of CUSP4MVP-VAP National Project
• Iowa• Michigan • New Jersey• Oklahoma • Pennsylvania• South Carolina• Tennessee• Texas• UHC
32
CUSP4MVP-VAP: MD and PA Opportunities
• MD and PA opportunities with National Project:
- Joining National Project content calls for continued
education on CUSP and VAE prevention
- Share your experience on content/coaching calls:
• as implementation experts
• to discuss implementation successes and barriers
33
CUSP4MVP-VAP: Content Call Schedule
Date: First Tuesday of every month (* Please note that this call does not follow the regular content call schedule)
Time: 2pm EST
Webinar Link: CUSP4MVP-VAP Content Calls
Call-in Information: 1-877-668-4493; Access code: 667 844 66534
Date Call Type and Module # Topic
February 5, 2014* Content Call, Module 1 CUSP 4 MVP-VAP Kickoff Webinar
February 18, 2014* Content Call, Module 2 Science of Safety & Identifying Defects
March 4, 2014 Content Call, Module 3
Pain, Agitation, and Delirium (PAD) - Delirium and Sedation Management
March 18, 2014* Content Call,
Module 4 PAD – Spontaneous Awakening Trials (SAT) and Spontaneous Breathing Trials (SBT)
April 1, 2014 Content Call, Module 5 Daily Early Mobility Overview
May 6, 2014 Content Call, Module 6
How to run a CUSP Team (Engaging all members of the CUSP team)
June 3, 2014 Content Call, Module 7 Daily Goals Facilitates VAE Prevention
July 1, 2014 Content Call, Module 8
Learning from Defects
Additional Resources
• Society for Critical Care Medicine ICU Liberation Group– http://www.iculiberation.org/Pages/default.aspx
• AHRQ CUSP Toolkit– http://www.ahrq.gov/professionals/education/curriculum-
tools/cusptoolkit/
• Armstrong Institute CUSP Tools– http://www.hopkinsmedicine.org/armstrong_institute/
training_services/cusp_offerings/cusp_guidance.html
• Armstrong Institute Training Opportunities– http://www.hopkinsmedicine.org/armstrong_institute/
training_services/cusp_offerings/
35
© The Johns Hopkins University and The Johns Hopkins Health System Corporation, 2011
Next Steps
Next Steps
• Collect Early Mobility data (January – March)
• Complete Exposure Receipt Assessment (February)
• Complete 2nd HSOPS (March)
• Begin data collection sampling strategy between process
measures and early mobility (April)
• Begin data collection for Low Tidal Volume Ventilation
measure (August)
37
Data Collection Sampling Strategy: Begins April 1st
38
2014 CUSP for VAP Data Collection Calendar
January
February
March
April
S M T W T F S
S M T W T F S
S M T W T F S
S M T W T F S
1 2 3 4
1
1
1 2 3 4 5
5 6 7 8 9 10 11
2 3 4 5 6 7 8
2 3 4 5 6 7 8
6 7 8 9 10 11 12
12 13 14 15 16 17 18
9 10 11 12 13 14 15
9 10 11 12 13 14 15
13 14 15 16 17 18 19
19 20 21 22 23 24 25
16 17 18 19 20 21 22
16 17 18 19 20 21 22
20 21 22 23 24 25 26
26 27 28 29 30 31
23 24 25 26 27 28
23 24 25 26 27 28 29
27 28 29 30
30 31
May
June
July
August
S M T W T F S
S M T W T F S
S M T W T F S
S M T W T F S
1 2 3
1 2 3 4 5 6 7
1 2 3 4 5
1 2
4 5 6 7 8 9 10
8 9 10 11 12 13 14
6 7 8 9 10 11 12
3 4 5 6 7 8 9
11 12 13 14 15 16 17
15 16 17 18 19 20 21
13 14 15 16 17 18 19
10 11 12 13 14 15 16
18 19 20 21 22 23 24
22 23 24 25 26 27 28
20 21 22 23 24 25 26
17 18 19 20 21 22 23
25 26 27 28 29 30 31
29 30
27 28 29 30 31
24 25 26 27 28 29 30
31
September
October
November
December
S M T W T F S
S M T W T F S
S M T W T F S
S M T W T F S
1 2 3 4 5 6
1 2 3 4
1
1 2 3 4 5 6
7 8 9 10 11 12 13
5 6 7 8 9 10 11
2 3 4 5 6 7 8
7 8 9 10 11 12 13
14 15 16 17 18 19 20
12 13 14 15 16 17 18
9 10 11 12 13 14 15
14 15 16 17 18 19 20
21 22 23 24 25 26 27
19 20 21 22 23 24 25
16 17 18 19 20 21 22
21 22 23 24 25 26 27
28 29 30
26 27 28 29 30 31
23 24 25 26 27 28 29
28 29 30 31
Key: Process Measure data collection Early Mobility data collection No data collection; use this time to catch up on missing Process Measure and Early Mobility data
Enhancing Support for MD and PA Teams
• Objective Outcome Data - Armstrong will analyze your data for outcome measures if you provide it– decreasing duration of mechanical ventilation– decreasing hospital length of stay– decreasing mortality
• How do we enhance horizontal learning?
• What can the AI/MHA/HAP team do to better support you?
39
Thank You
A sincere
THANK YOU
for all of your effort
and hard work to
reduce the incidence of VAP
in your units
and prevent HAIs!
40
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