Interdisclipinary Communication:Thinking Outside the Bundle to Eliminate VAPs in Trauma Patients

Saturday, 16 November 2013: 3:15 PM

Marlienne Goldin, RN, BSN, MPA
Neuro Intensive Care Unit, Moses Cone Memorial Hospital, Greensboro, NC

Learning Objective 1: Relate increased interdisclipinary communication's effect on decreased Ventilator Associated Pneumonia rates in the Neuro ICU.

Learning Objective 2: Relate daily checklist implementation to improved ICU patient outcomes

Purpose:Ventilator-associated pneumonia (VAP) is a significant problem in trauma patients increasing mortality and cost of care. While monitoring adherence to VAP prevention strategies reflected 98% compliance, our VAP rate revealed monthly variation (0-34) and a plateau for two consecutive years (8.04).  Neuro ICU Nurses recognized the need to apply different strategies to impact trauma patients’ outcomes. A team was created for the purpose to decrease VAP in the trauma patients.

 Description:Our critical care nurses and Trauma Services recognized the importance of an interdisciplinary approach in their efforts to decrease the incidence of VAP. Additional stakeholders were added to the team including a dietitian, pharmacist, respiratory and physical therapist and leadership from both nursing and respiratory therapy. A review of the literature revealed the positive impact of team rounding and use of an interdisciplinary tool on VAP rates. Each discipline was responsible for confirming specific evidenced-based practices that prevent VAP. These strategies were then embedded into a check-off tool to be used during rounding.  Initially, interdisciplinary team rounding occurred twice a week. Modifications to the tool occurred frequently to improve communication during rounding. Recognizing the impact that rounding made on ensuring timely interventions, the Neuro ICU began using the tool to round every day on all ventilated patients while maintaining biweekly interdisciplinary rounding with the Trauma Services.  

 Evaluation and Outcomes: Since implementation of intentional VAP rounding and daily use of the interdisciplinary tool, Trauma Services have experienced a zero VAP rate for six consecutive months. Implementing the same process on every ventilated patient, the Neuro ICU has decreased their overall VAP rate from 3.0 to 1.54 over the same period. Vigilance to ensure continued rounding and prompt implementation of interventions continues to be a strategy supported by leadership.