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Calhen checklist

VAP: Ventilator Acquired Pneumonia
Primary Drivers

Secondary Drivers
Standardize processes and care
Institute a standardized protocol or bundle for the care of a
reminders
bundle reminders and checklists on a flow sheet or EMR checklist
Elevate Head of Bed raised between
visual cues so it is easy to identify when the bed is in the proper
30-45 degrees
position, such as a line on the wall that can only be seen if the bed is below a 30-degree angle Include the clues on order sets for initiation and weaning of mechanical
ventilation, delivery of tube feedings, and provision of oral care Create an environment where respiratory therapists work collaboratively
with nursing to maintain head-of-the-bed elevation
Peptic ulcer disease (PUD) prophylaxis
Evaluate the use of medications (H2 blockers are preferred over
sucralfate). Proton pump inhibitors may be efficacious and an alternative to sucralfate or H2 antagonist PUD on the ICU order admission set and ventilator order set
review of PUD into daily multidisciplinary rounds
Engage pharmacy in daily multidisciplinary rounds to ensure ICU patients
have some form of PUD and VTE prophylaxis Venous Thromboembolism (VTE)
VTE prophylaxis on all mechanically ventilated patients unless
prophylaxis
Include VTE prophylaxis as part of your ICU order admission set and
ventilator order set
Spontaneous Awakening Trials (SAT)
Develop protocols, order sets, and standard work for spontaneous
and Spontaneous Breathing Trials
awakening trials (SAT) and spontaneous breathing trial (SBT) daily assessments of readiness to wean and extubate
Create an environment where respiratory therapists work collaboratively
with nursing to facilitate a daily “sedative interruption” in coordination
to “weaning trials”
Implement a protocol to lighten sedation daily to assess for readiness
to extubation. Include precautions to prevent self-extubation such as increased monitoring during the trial For more information, please refer to HRET’s change package VAP (continued)
Primary Drivers
Secondary Drivers
Oral Care
regular oral care with an antiseptic solution (e.g., chlorhexidine)
in accordance with the manufacturer’s product guidelines Include daily oral care with chlorhexidine as part of your ICU order
admission set and ventilator order set
Educate the RN staff about the rationale for supporting good oral hygiene
and its potential benefit in reducing ventilator-associated pneumonia Patient and Family Engagement
Standard practice includes patient and family preparation for intubation
Include the patient and family in daily care activities or expectations
patient and family education in their preferred language
unit level information or feedback about patients that experience
a ventilator acquired pneumonia to staff members (e.g., unit posted graphs
or dashboards, staff meeting discussions, or daily huddle discussions)
For more information, please refer to HRET’s change package

Source: http://ddcache1.net/calhospital.s1017.SU/sites/main/files/file-attachments/pages_from_calhen_checklist_042613_3-10_vap.pdf

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