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CS68
BUDAS: Mechanical Ventilation Care Bundle
By Melanie Roberts, Poudre Valley Hospital, Windsor, CO
For further information, please contact: mgr@pvhs.org
Purpose: In April of 2002, the Infection Control committee reported the ventilator associated pneumonia rate for 2001 of 13.18 with the CDC National Nosocomial Infection Surveillance (NNIS) comparison of 5.27. Nursing leadership, the Medical Director, and Respiratory Therapy formed a multidisciplinary team to determine an action plan.
Description: The primary concern was for morbidity and mortality. Evidence based medicine clearly states prevention is the best option and a bundled approach creates a more robust improvement. The multidisciplinary team implemented a multidimensional approach to reduce the ventilator associated pneumonia rate by 10% and insure 100% of mechanically ventilated patients received all components of the bundle. Our Medical Director created the acronym “BUDAS” to represent the ventilator care bundle: B=Head of bed greater than 30 degrees, U=Ulcer prophylaxis, D=Deep Vein Thrombosis prophylaxis, A= Anemia (monitor hemoglobin and treat appropriately), S=Sedation wake-up. For one month prior to implementing changes, the CNS conducted an audit of mechanically ventilated patients. The total number of patients was 20; only 30% of those patients received all components of the bundle. Using PDCA format, a plan for education was developed and executed. To make the practice changes part of daily routines, multidisciplinary daily rounds were implemented.
Evaluation/Outcomes: Compliance with BUDAS is audited monthly: 1Q03 (94%), 2Q03 (85%), 3Q03 (92%), 4Q03 (90%), 1Q04 (95%), 2Q04 (99%). In 2002, the ICU had 10 ventilator associated pneumonias, for a rate of 6.88 compared to NNIS of 5.99. In 2003, the ICU had 3 ventilator associated pneumonias for a rate of 2.75 compared to a NNIS of 5.99. Year to date for 2004 there have been 2 ventilator associated pneumonias for a rate of 3.07, compared to NNIS of 5.99. The BUDAS approach is decreasing ventilator associated pneumonias and the associated morbidity and mortality.
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