CUSP 4 MVP VAP Improving Care for Mechanically Ventilated Patients Data Feedback: SubG ETT, Head of Bed Elevation and Delirium Assessment Utilization ARMSTRONG INSTITUTE FOR PATIENT SAFETY AND QUALITY Johns Hopkins University 2 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar 3 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar Webinar Objectives 1.Review data submission rates and results for SubG ETT, HOB, and delirium assessment use. 2.Discuss how collecting this data has fueled improved care for mechanically ventilated patients in ICUs. 3.Review the process for accessing and downloading data reports. 4 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar Daily Care Processes Cohort 1 Data Collection Schedule 5 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar Daily Care Processes Sub-G ETT, HoB, Delirium 6 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar Daily Care Processes Data Completion Rates Number of Cohort 1 Units*N% Total active hospital units 41100% Number of hospital units that have submitted data 2868% Number of hospital units that have never submitted data 1332% * As of March 10, 2015 7 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar Subglottic Endotracheal Tubes Usage of subglottic endotracheal tubes are recommended. Visit https://armstrongresearch.hopkinsmedicine.org/cusp4mvp/processmeasures.aspx for fact sheets and literature reviews.https://armstrongresearch.hopkinsmedicine.org/cusp4mvp/processmeasures.aspx 8 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar Subglottic Suctioning Study 1 Randomized controlled clinical trial conducted in five ICUs of the same hospital Confirm effect of subglottic secretion suctioning on VAP prevalence to assess concomitant impact on VAC and antibiotic use N=352 adult patients intubated with tracheal tube allowing subglottic secretion suctioning N=170, group 1 underwent suctioning N=182, group 2 did not undergo suctioning Damas P, Frippiat F, Ancion A, Canivet JL, Lambermont B, Layios N, Massion P, Morimont P, Nys M, Piret S, Lancellotti P, Wiesen P, D'orio V, Samalea N, Ledoux D. Prevention of ventilator-associated pneumonia and ventilator-associated conditions: a randomized controlled trial with subglottic secretion suctioning. Crit Care Med Jan;43(1): PMID: 9 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar Results of Subglottic Suctioning Study Suction Group 1 (n=170) No Suction Group 2 (n=182) VAP8.8%, 15 patients17.6%, 32 patients VAP by vent days9.6 of 1000 days19.8 of 1000 days VAC21.8%22.5% Antibiotic days61% 1696 of 2754 days 68.5% 1965 of 2868 days 10 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar Impact of Subglottic Secretion Suctioning Significant reduction of VAP prevalence Significant decrease in antibiotic use Among 47 patients with VAP, 25 (58.2%) experienced a VAC VAC did not differ between groups Related to other medical features, rather than VAP Neither ICU LOS nor mortality differed Only VAC associated with increased mortality 11 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar Subglottic Endotracheal Tube Calculations Numerator Total number of patients with first Sub-G ETT value being Yes Denominator Total number of patients with first Sub-G ETT value being either Yes or No 12 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar Subglottic Endotracheal Tube Utilization Rates 13 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar Subglottic Endotracheal Tube Utilization Rates Q Q Q Q SubG ETT Utilization Rates26.5%27.0%30.3%19.1% Number of patient days in which SubG ETT were used (numerator) Number of SubG ETT-eligible patient days (denominator) 14 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar Head of Bed Elevation 30 The elevation of the head of bed to a semi-recumbent position (30 degrees) is associated with a decreased incidence of aspiration and Ventilator- Associated Pneumonia (VAP). Visit https://armstrongresearch.hopkinsmedicine.org/cusp4mvp/processmeasures.aspx for fact sheets and literature reviewshttps://armstrongresearch.hopkinsmedicine.org/cusp4mvp/processmeasures.aspx 15 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar Head of Bed Elevation 30 Compliance Calculations Numerator Total number of patient- days with HoB 30 being Yes Denominator Total number of patient-days with HoB 30 being either Yes or No 16 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar Head of Bed Elevation 30 Compliance Rates 17 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar Head of Bed Elevation 30 Compliance Rates Q Q Q Q HoB Elevation Rates97.8%98.4%97.7%99.4% Number of patient days in which HoB elevation was used (numerator) Number of HoB-eligible patient days (denominator) 18 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar Delirium Assessments Adult ICU patients should be assessed for delirium using at least once per shift. The Confusion Assessment method for the ICU (CAM-ICU) is a recommended tool to for assessing delirium. Visit https://armstrongresearch.hopkinsmedicine.org/cusp4mvp/processmeasures.aspx for fact sheets and literature reviews.https://armstrongresearch.hopkinsmedicine.org/cusp4mvp/processmeasures.aspx 19 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar Delirium Assessment Utilization Calculations Numerator Total number of patient days with Intub/Trach & Mech Vent marked Yes and 1.CAM-ICU is marked Positive or Negative or; 2.A numeric ASE value is recorded 20 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar Delirium Assessment Utilization Calculations Denominator Total number of patient days with Intub/Trach & Mech Vent marked Yes and 1.CAM-ICU is marked Positive or Negative or X Not completed or NK-Not Known or; 2.A numeric ASE value or ASE is marked X or NL 21 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar Delirium Assessment Utilization Rates 22 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar Delirium Assessment Utilization Rates Q Q Q Q Delirium Utilization Rates67.9%78.8%94.8%94.5% Number of patient days in which delirium assessments were issued (numerator) Number of delirium assessment-eligible patient days (denominator) 23 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar Summary SubG ETT ~ 25% utilization rate overall HoB >95% utilization rate overall Delirium Assessment Between 60-95% utilization rate overall 24 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar Next Steps Continue using the Daily Care Process Data Collection Tool to track progress. Continue entering data into the data portal receive data reports and monitor improvement. Work with hospital leaders to institute subglottic endotracheal tubes usage in your ICU. 25 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar Helpful Links Fact sheets and literature reviews https://armstrongresearch.hopkinsmedicine.org/cusp4mvp/processmeasur es.aspx Data Measures Definitions and Formulas (Scroll to bottom of page and click on Data Measures Definitions) https://armstrongresearch.hopkinsmedicine.org/cusp4mvp/datatools.aspx CUSP 4 MVP-VAP Data Portal https://armstrongresearch.hopkinsmedicine.org/MyTools.aspx How to Access Data Reports 27 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar Go to the CUSP 4 MVP VAP Homepage: https://armstrongres earch.hopkinsmedic ine.org/cusp4mvp.a spx. https://armstrongres earch.hopkinsmedic ine.org/cusp4mvp.a spx Click on Data Entry and Reports. 28 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar Log in. 29 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar Click on My Network Performance. 30 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar Choose the time period that you want. Choose the app that you want. 31 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar Click View Chart under the measure that you would like to view. In this example, we are looking at Delirium Assessment Compliance Rates. 32 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar A graph will appear on the bottom. Click the PDF icon to download the report. 33 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar 34 CUSP 4 MVP VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar