It Takes a Village

Contra Costa Regional Medical Center

Stuart Forman, MDKathryn Moore, OTR/L

Ronald Marquez, PTAngela Bennett, RN

Trent Tate, RCP

Where we were

VAP Rate/ 1000 ventilator days

Where we are now

Last VAP January 2011

How did we get there?

Step 1: Examine the evidence

Step 2: Find a Champion

Step 3: Engage a team

Step 4: Small tests of change

Step 5: Rapid Cycle Improvement

Step 6: Build on Success

ABCDE Building Blocks

• Wake up and breath protocols• Ventilator bundles• CAM-ICU • Daily ventilator rounds• ICU OT/PT staffing

What Were Our Barriers?• Inertia• Staffing• Skeptical doctors• Antiquated chart system• Data gathering

How Did We Overcome These Barriers?

• EBM• Use people’s normal work flow• Invite participation from all team members• Showcase results• Engage quality and infection control managers

What Did We Learn From This Improvement Effort?

• Don’t try everything at once• Culture beats strategy • Engaged leaders • Put front line workers in charge• Data collection is not easy

What Can We Teach From Our Journey?

• Step 1: Find the evidence of efficacy• Step 2: Find a champion• Step 3: Engage the team• Step 4: Small tests of change• Step 5: Rapid cycle improvement—don’t

expect perfection• Step 6: Share and build on your successes• Step 7: Lather, rinse repeat

Feel Free to Contact Us:

Stuart Forman, MD, FAAFPMedical Director, Critical Care Services2500 Alhambra Ave.Martinez, CA 94553

Stuart.forman@hsd.cccounty.us