SICSAG VAP Prevention Bundle – does it work ? - PowerPoint PPT Presentation

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SICSAG VAP Prevention Bundle – does it work ?

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1 VAP Paatient non compliant, pulled trachy out x1 and constantly pulled at it. Still working on daily goals. 17 March. opportunities possible. opportunities taken. – PowerPoint PPT presentation

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Title: SICSAG VAP Prevention Bundle – does it work ?


1
SICSAG VAP Prevention Bundle does it work ?
Malcolm Daniel, Andrew Longmate, Kevin Rooney
2
Aims
  • To review data from Scottish Centres
  • To look at interpretation of run charts
  • To look at ways of improving care

3
  • SICSAG VAP Prevention Bundle Jan 2008
  • http//www.sicsag.scot.nhs.uk/SubGroup/HAI.htmlpu
    b
  • Beard D, Booth M, Cook B, Cole S, Crofts S,
    Curran S, Kellagher A, Longmate A, Swann D
  • Sedation to be reviewed and, if appropriate,
    stopped each day
  • All patients will be assessed for weaning and
    extubation each day
  • Avoid supine position, aiming to have the
    patient at least 30 head up
  • Use Chlorhexidine as part of daily mouth care
  • Use subglottic secretion drainage in patients
    likely to be ventilated for more than 48 hours

4
What is the variation in one system over time?
Walter A. Shewhart - early 1920s, Bell
Laboratories
Dynamic View
Static View
Static View
LCL
  • Every process displays variation
  • Controlled variation
  • stable, consistent pattern of variation
  • chance, constant causes
  • Special cause variation
  • assignable pattern changes over time

Static View
5
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6
NHS Dumfries and Galloway Royal Infirmary VAP
Rate
Shift downward and sustained
7
NHS Tayside Ninewells ICU VAP Rate
Shift downward and sustained
8
Remember
  • These are outcomes
  • Are processes important ?
  • Remember processes drive outcomes
  • Structure Process Outcome
  • (Avedis Donabedian 1966)

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13
Repeated Use of the Cycle
Changes That Result in Improvement
DATA
Implementation of Change
Wide-Scale Tests of Change
Follow-up Tests
Hunches Theories Ideas
Very Small Scale Test
14
Improvement vs. ResearchContrast of
Complementary Methods
  • Improvement
  • Aim
  • Improve practice of health care
  • Methods
  • Test observable
  • Stable bias
  • Just enough data
  • Adaptation of the changes
  • Many sequential tests
  • Assess by statistical significance
  • Clinical Research
  • Aim
  • Create New clinical knowledge
  • Methods
  • Test blinded
  • Eliminate bias
  • Just in case data
  • Fixed hypotheses
  • One fixed test
  • Assess by statistical significance

15
National Results
16
Conclusions
  • SICSAG developed a VAP Prevention Bundle
  • Key step is working on improvement in process
    reliability
  • Improvement in process reliability is driving a
    reduction in VAP rate

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20
Sustainability Key Concepts
  • Leadership Support
  • Systems approach
  • Interdisciplinary Teams
  • Standardise and Simplify work
  • Embed Measurement in Daily Work
  • Real Time Process Measurement
  • Real Time Outcome Measurement
  • Transparency and Avoidance of Blame

21
Blue to Yellow published
  • Reduction of Ventilator Associated Pneumonia
    Active versus Passive Guideline Implementation.
  • C Hawe, KS Ellis, CJS Cairns, A Longmate.
    Intensive Care Medicine 2009 35 1180-1186

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Unit 1
Unit 2
Unit 3
R Lloyd, Institute for Healthcare Improvement
24
Limitations and Strengths
  • Non-controlled
  • Non blinded
  • Confounding variables
  • Other changes
  • VAP definition
  • Hawthorne
  • Continuous measurement
  • Validated definitions
  • Clear link between process and outcome
  • Consistent with other studies

25
Some u chart rules
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Drawing new limits
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Architecture of Quality Improvement Programmes
30
Secondary DriverVAP prevention screening for
weaning
Cycle 1Econsolidation
Cycle 1D recording on WW at midnight
Cycle 1C daily prompt sheet charge
nurse-(police)
Cycle 1B 1-3-5 nurses. Recorded on 24hr chart
Cycle 1A Stickie developed (using existing
agreed work) trialled with one nurse several
times
Testing Trigger Screening for Weaning
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