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CS64
HEADS UP!!! Promoting Compliance in Clinical Practices to Prevent Ventilator-Associated Pneumonia
By Elaine Killough, Sturdy Memorial Hospital, Attleboro, MA
For further information, please contact: eladorn@aol.com
Purpose: Ventilator-associated pneumonia (VAP), contributes to increased morbidity and mortality in critical illness, and is preventable. CDC guidelines recommend backrest elevation (BRE) at ≥30º as a primary intervention (Class 1B) to prevent VAP. Compliance, however, has been demonstrated to be generally poor. In our adult medical-surgical ICU, forty random observations showed a mean BRE of 22.4º with compliance of only 10%. Our goal was to improve compliance using an evidence-based intervention that would support quality-focused prevention initiatives for patients at risk for VAP.
Description: Our intervention incorporated four recommendations suggested to be effective in changing clinical practice: education, reminders, documentation, and feedback. A comprehensive education package included an inservice, computer access to related information and literature, and a poster. A visual reminder sticker, attached to the bedside documentation binder, depicted a large red stop sign stating “HEADS UP ≥ 30º to prevent VAP!” To increase accountability, a BRE field in the electronic record that had been reserved for hemodynamics, was opened for documentation of BRE every four hours for patients at risk for VAP. Biweekly feedback on progress was provided at two week intervals, using posted graphs and e-mails.
Evaluation/Outcomes: A total of 593 follow-up observations were recorded over five months. Compliance with BRE ≥30º for appropriate patients improved steadily to 95% in the final two week interval. Mean BRE by interval ranged from 30.9º to 34.0º. In the six-month period that included the intervention, the incidence of VAP (cases per 1000 vent days) decreased by 15%, and has continued to decrease (29% to date). Although preventing VAP is a multi-factorial process, our outcomes are consistent with the suggested benefits of keeping BRE ≥30º, and demonstrate the effectiveness of an evidence-based approach to changing clinical practice and promoting compliance.
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