Paper
Friday, 21 July 2006
This presentation is part of : Critical Care Initiatives
Creating a Culture of Safety Through Collaboration
Marlienne Goldin, RN, BSN, MPA, Medical Intensive Care Unit, St. Barnabas Health Care System, Newark Beth Israel Medical Center, Newark, NJ, USA
Learning Objective #1: relate the importance of interdisciplinary collaboration to successfull implimentation of critical care protocols.
Learning Objective #2: relate application of best practice guidelines to improved patient safety.
Patient safety has become the primary goal of health care in the United States. Mechanical ventilation is the main cause of nosocomial pneumonia in the critical care setting.  This study was conducted to assess if implementing best practice, and adherence to a culture of safety, would reduce ventilator associated pneumonia, (VAP), in the ICU of a 500 bed teaching hospital. Studies have shown that hospital acquired pneumonia increases a patient’s length of  ICU stay by 6.1 days, and hospitalization by 10.5 days.  Pneumonia increases the need for antimicrobial therapy, causing further complications due to the increase in multi antibiotic resistant strains of bacteria in the ICU.  Does decreasing ventilator time result in a decrease in the ICU acquired pneumonia rate?  Does implementing best practice result in increased patient safety?  In June of 2004 the staff of the ICU, through strong collaboration between physicians, nurses, and respiratory therapists, initiated daily screenings of all ventilated ICU patients.  Nurses on every shift assess readiness to extubate by performing spontaneous breathing trials.  The vent bundle consisting of raising the head of bed, DVT prophylaxis, oral care, and peptic ulcer disease prophylaxis was also introduced and initiated. Ventilator days were reduced from 6.1 in 2004 to 4.0 in the first three quarters of 2005.  There have not been any cases of ventilator acquired pneumonia in the ICU from June of 2004 to November of 2005.  From a bench mark of 5.8% on 2004 we now have a 0% VAP rate in the first 3 quarters of 2005.  Strong multidisciplinary collaboration resulted in the development and adherence to ICU protocols.  Early extubation, combined with best practice for ventilated patients, results in a decrease of ventilator acquired pneumonia.  We believe that adopting other best practice initiatives can further reduce ICU morbidity and mortality thereby increasing patient safety.

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See more of The 17th International Nursing Research Congress Focusing on Evidence-Based Practice (19-22 July 2006)