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
REZA FARID HOSSEYNI, MD, DTCT, FAAAAI 55 Nastran Ave. Nasteran 8 Mashhad, Iran rfaridh@yahoo.com Home: 0098 511 761 15 80 Cell: 0098 915 111 13 80 Fax: 0098 511 761 06 81 Intrested Research : HTLV-1 , Allergic disease Adjunct Professor of Allergy Health Promotion Sciences Adjunct Professor of Immunology College of Medicine . The University Of Arizona Mel and Enid Zuckerman College of Public
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