Learning Objective #1: Analyze the evidence-based standards of care for patients on a ventilator

Learning Objective #2: Identify the results of a performance improvement initiative to reduce ventilator-associated pneumonia

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Critically ill patients who need mechanical ventilation are at high risk for the development of pneumonia during the course of treatment. Ventilator-associated pneumonia (VAP) leads to higher rates of mortality and morbidity, increased length of hospital stay, and higher hospital costs. Prior to 2001, according to the CDC, the VAP rate was 10.7 per 1000 ventilator days. In 2001, the national average was 5.7 VAP per 1000 ventilator days. At Blessing Hospital in 2003, the rate was 8.06. Upon review by the Safety Committee at Blessing Hospital it was determined that there was an opportunity for improvement to reduce the VAP rate.

An interdisciplinary team was formed and led by a Registered Nurse from ICU. The initial business was to educate the team about VAP and the national standards, evidence-based practice, and best practices identified in the literature. The team set a goal for reducing the VAP at Blessing Hospital to 5.0 cases/1000 ventilator days.

The team developed a Standard of Care for Ventilator Patients. The staffs of all involved in the care of ventilator patients were educated on the changes. The new standard of care includes: use of pre-printed mechanical ventilator orders on all ventilator patients; closed suction set-up; suction every 2 hours and prn; physical therapy and dietician consult; head of bed elevated 30 degrees; oral care every 2 hours; and meticulous handwashing.

The outcomes of this Evidence-Based Practice change project include: a reduction in the annual VAP rate to 3.53 per 1000 ventilator days, enhanced interdisciplinary collaboration, teamwork, true patient advocacy, and staff involvement in quality patient care decision-making.