Hospital recognized for efforts to eliminate ventilator associated pneumonia
Twin Cities Community Hospital Director of Critical Care Sheila McMillan and Cynthia Kellerman, a team of intensivists, nurses, respiratory therapists and physical therapists have been selected to present their abstract about “Best Practices in Ventilator Care” at the 2014 Association of California Nurse Leaders annual program in Monterey, California from February 9-12, 2014.
The poster abstract provides details about the hospital’s project, “Achievements in Eliminating Ventilator Associated Pneumonia (VAP),” a summary of the hospital’s findings and critically acclaimed methods in eradicating VAP entirely from its 10-bed ICU since 2008.
With an estimated 33- to 50-percent mortality rate, VAP is a dangerous bacterial infection of the lungs associated with undergoing mechanical ventilation in a hospital. The Twin Cities Community Hospital team began rigorous work in improving incidences of VAP in the last quarter of 2006, in response to a 2006 VAP rate of 4.9 (three cases), which was well above the desired Tenet Balanced Scorecard target of 1.3 and higher than the National Healthcare Safety Network (NHSN) 25th percentile rating of 0.93.
The hospital charged McMillan and her team with a two-part task: to design and implement VAP bundling practices using evidence-based outcomes; and to demonstrate significantly lower rates of VAP infections, meeting Tenet Balanced Scorecard targets and NHSN percentile benchmarks.
McMillan explains that the team approached the objective by initiating the Institute for Healthcare Improvement (IHI) Ventilator Bundling Practices and additional stringent VAP bundling practices from that point through 2009. From 2006 to present, the team adopted intensive education and quality monitoring efforts, as well as performing practices such as early mobilization and increased use of bilevel positive airway pressure (BIPAP) in the place of invasive ventilation, when appropriate, to further improve VAP rates.
“As a result, our ICU measured statistically significant lower VAP rates and has been VAP free since November 2008,” reports McMillan, the primary presenter of the project. “We have been proud to share our evidence based practices and results and hope our work aids in the effort to eliminate this dangerous illness from hospitals everywhere.”
As a result of reducing its VAP rate to a 0.0 rate, Twin Cities received an “A” Safety Score from The Leapfrog Group, an employer-based coalition advocating for improved transparency, safety and quality in hospitals; recognition from The Joint Commission as a Top Performer in Key Quality Measures in Heart Failure, Pneumonia, and Surgical Care; and “Outstanding Achievement and Leadership: Elimination of Ventilator Associated Pneumonia” in 2012 and an Honorable Mention for the same in 2013 from the U.S. Department of Health and Human Services and Critical Care Collaborative.
“Sheila McMillan and her team worked tirelessly since 2006 to develop and maintain industry-leading practices and an impeccable culture of safety in order to eliminate VAP in our ICU,” says Carol Howland, Chief Nursing officer at Twin Cities. “It’s a remarkable, noble achievement for Twin Cities Community Hospital and the local community, as well as for the entire medical field which can now benefit from her team’s successful methodology.”
McMillan will present the detailed abstract poster to the ACNL, an organization which has been developing nurse leaders, advancing professional practice, influencing health policy and promoting quality and patient safety for more than 35 years, in February 2014, as well as at the annual Nurses Improving Care for Healthsystem Elders (NICHE) conference in April 2014.
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