CUSP for VAP: Year in Review

© The Johns Hopkins University and The Johns Hopkins Health System Corporation, 2011

CUSP for VAP: Year in Review

Sean Berenholtz, MD, MHS

Kathleen Speck, MPH

The Armstrong Institute for Patient Safety and Quality

February 6, 2014

CUSP for VAP: Project Review

• NIH/NHLBI and AHRQ funded project

– Individual hospitals participate for 3 years, including 2 year

intervention period and 1 year sustainability period

• Leveraging leaders in field

– Armstrong Institute for Patient Safety and Quality, NIH/NHLBI, CDC,

AHRQ, University of Pennsylvania

– Maryland Hospital Association

– Hospital and Healthsystem Association of Pennsylvania

2

Project Goals

• Our objectives were:

– To achieve significant reductions in VAE rates

– To achieve significant improvements in safety culture utilizing the

components of CUSP

– To advance the science of VAP prevention utilizing:

- Updated VAP prevention bundle

- New CDC NHSN VAP definition

- Identification of contextual variables that foster/impede the

implementation of QI projects

3

• Key concepts: Adaptive and Technical Work

How Will We Get There?

4

Why Safety Culture Matters?

1. Safety culture is related to outcomes

– Patient outcomes• Patient care experience

• Infection rates, sepsis

• Postop. hemorrhage, respiratory failure, accidental puncture/laceration

• Treatment errors

– Clinician outcomes• Incident reporting, burnout, turnover

5

Huang et al., 2010; Mardon et al., 2010; MacDavitt et al., 2007; Singer et al., 2009; Sorra et al., 2012; Weaver, 2011.

Why Safety Culture Matters?

2. Safety culture influences the effectiveness of other safety and quality interventions

– Can enhance or inhibit effects of other interventions

3. Safety culture can change through intervention

– Best evidence so far for culture interventions that use multiple components

6Haynes et al., 2011; Morello et al., 2012; Van Nord et al., 2010; Weaver et al., in press

Technical Work

• Project currently in 2nd year of implementation phase

• We have introduced the following VAP prevention measures to reduce VAE rates:

- Process Measures • HOB• Sub-G ETT• Oral care• Oral care with CHG• SAT

• SBT

- Early Mobility

7

Adaptive Work

• We have introduced the following CUSP tools:

- CUSP Components• Science of Safety

• Learning from Defects

• Engaging Senior Executives & Leadership

• Daily Goals

• Culture Checkup

• Shadowing

• Daily Briefing

• Barrier identification and Mitigation

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Project Resources

• VAP Tools– https://armstrongresearch.hopkinsmedicine.org/vap/

vap/resources.aspx

• CUSP Tools– https://armstrongresearch.hopkinsmedicine.org/vap/

cusp/resources.aspx

• Recordings and Slide Presentations for CUSP and VAP Webinars– https://armstrongresearch.hopkinsmedicine.org/vap/

calls.aspx

9

MD and PA Teams Are Engaged: MedConcert

Teams have shared tools and protocols via MedConcert:•Holy Cross Hospital MICU – Noon Charge Nurse Update Protocol

•University of Maryland Shore Health Hospitals - ABCDE Protocol

•Johns Hopkins Hospital WICU – VAP Family Involvement Sign-In Protocol

•Western Maryland Health System – Vent Weaning Protocol

•Meritus Medical Center – Vent Weaning Pocket Protocol

•St. Agnes Hospital – Flow Sheet, Mechanical Vent Weaning Protocol, Mechanical Vent

Management Protocol, Drug Administration Protocol

•Maryland Hospital Association - VAP Talking Points Document

MedConcert Link:•https://www.medconcert.com/

10

MD and PA Teams Are Engaged:Content/Coaching Call Participation

Teams have presented their experiences on CUSP/VAP content/coaching calls:

•St. Agnes Hospital AICU - Early Mobility

•Magee Rehabilitation Hospital SCI - Early Mobility

•Troy Hospital ICU – Early Mobility

•Johns Hopkins Hospital WICU – Learning from Defects

•Prince George’s Hospital ICU – PreMortem

•Johns Hopkins Bayview Medical Center MICU – PreMortem

•Sinai Hospital of Baltimore ICU - PreMortem

11

MD and PA Teams Are Engaged:Exposure Receipt Assessment Pilot

Teams have helped to pilot the Exposure Receipt Assessment and provided feedback:

•Western Maryland Health System CVU and ICU

•MedStar St. Mary's Hospital ICU

•Meritus Medical Center CCU

•Doylestown Hospital ICU

•St Joseph's Hospital ICU

•Brandywine Hospital ICU

12

MD and PA Teams Are Engaged:Early Mobility

Helped to develop the Early Mobility Data Collection Instrument

•St. Agnes Hospital AICU

•Magee Rehabilitation Hospital SCI

•Troy Hospital ICU

Helped to pilot the Early Mobility Data Collection Instrument

•Johns Hopkins Hospital WICU, SICU, CVSICU

13

MD and PA Teams Are Engaged:Video Submissions

• Teams have shared stories via video submissions:

14


Reports: 2013 – A Year in Review

REPORTS

• Report highlights from of several assessments in 2013:

i. Summary Reports (Process Measure Data)

ii. VAE Rates

iii. Structural Assessment

iv. Exposure Receipt Assessment – Pilot

v. Quarterly Interviews

16

Compliance Reports: VAP Daily Process Measures (Q1-Q3 2013)

Compliance Rates - Aggregated

Q1 2013 Q2 2013 Q3 2013 P-value*(Q1 vs. Q3)

Data Entry Completion Rate

70% 71% 70% -

HOB

97%(13783/14201)

98%(12569/12834)

99%(7615/7711)

<0.001

Sub-G ETT30%

(527/1762)39%

(624/1604)38%

(320/845)<0.001

Oral Care67%

(9352/14006)71%

(8774/12388)76%

(5076/6664)<0.001

Oral Care with CHG

81%(10623/13097)

86%(10109/11720)

83%(5306/6398)

0.002

SAT74%

(6566/8815)76%

(6287/8227)78%

(3467/4436)<0.001

SBT67%

(6227/9243)74%

(5690/8067)70%

(3056/4341)<0.001

17

* The P-value was obtained by performing a Fisher’s Exact Test.

Table 1: Compliance Report for Daily Process Measures

Completion Rates: VAP Daily Process Measures (Q1- Q3 2013)

18

Hospital/Unit Jan 2013 Feb 2013 Mar 2013 Apr 2013 May 2013 Jun 2013 Jul 2013 Aug 2013 Sep 2013 Oct 2013 Nov 2013 Dec 2013 Jan 2014Anne Arundel Medical Center - Critical Care Unit 0 % 0 % 0 % 0 % 0 % 0 % 0 % 0 % 0 % 0 % 0 % 0 % 0 %

Bon Secours Baltimore Health System - ICU 6 5 % 3 9 % 8 1 % 8 0 % 9 0 % 1 0 0 % 8 4 % 7 4 % 9 3 % 9 4 % 8 7 % 5 5 % 0 %

Dorchester General Hospital - ICU 0 % 0 % 0 % 0 % 0 % 0 % 0 % 0 % 0 % 0 % 0 % 0 % 0 %

Holy Cross Hospital - CCU 8 4 % 8 9 % 9 7 % 9 7 % 1 0 0 % 1 0 0 % 9 7 % 9 4 % 5 3 % 0 % 0 % 0 % 0 %

Holy Cross Hospital - ICU 7 1 % 8 6 % 8 7 % 8 0 % 8 1 % 1 0 0 % 9 4 % 9 4 % 5 3 % 0 % 0 % 0 % 0 %

Holy Cross Hospital - SICU 6 % 9 6 % 9 4 % 8 3 % 8 1 % 8 7 % 8 1 % 7 7 % 8 3 % 0 % 0 % 0 % 0 %

Howard County General Hospital - Intensive Care Unit 6 5 % 6 4 % 7 1 % 9 3 % 8 7 % 7 7 % 7 4 % 6 1 % 8 3 % 8 7 % 8 3 % 8 1 % 2 9 %

Johns Hopkins Bayview Medical Center - CICU 8 4 % 1 0 0 % 1 0 0 % 1 0 0 % 9 0 % 1 0 0 % 9 0 % 1 0 0 % 2 7 % 0 % 0 % 0 % 0 %

Johns Hopkins Bayview Medical Center - MICU 1 0 0 % 1 0 0 % 9 0 % 9 7 % 9 0 % 1 0 0 % 8 4 % 1 0 0 % 1 7 % 0 % 0 % 0 % 0 %

Johns Hopkins Hospital & Health System - CVSICU 1 0 0 % 8 9 % 8 7 % 1 0 0 % 1 0 0 % 9 7 % 1 0 0 % 1 0 0 % 1 0 0 % 9 0 % 5 3 % 4 5 % 0 %

Johns Hopkins Hospital & Health System - NCCU 1 0 % 4 3 % 1 0 % 0 % 0 % 1 7 % 1 3 % 1 6 % 3 7 % 0 % 0 % 0 % 1 0 %

Johns Hopkins Hospital & Health System - SICU 4 8 % 5 4 % 4 5 % 4 3 % 6 8 % 6 3 % 7 1 % 3 9 % 5 3 % 4 5 % 3 3 % 3 2 % 6 %

Johns Hopkins Hospital & Health System - WICU 8 4 % 8 6 % 9 0 % 9 3 % 9 0 % 8 7 % 9 0 % 9 4 % 8 0 % 2 6 % 0 % 0 % 0 %

Laurel Regional Hospital - 4B Spellman Specialty 6 5 % 6 8 % 5 5 % 1 3 % 6 % 3 % 1 0 % 1 6 % 3 0 % 0 % 0 % 0 % 0 %

Laurel Regional Hospital - Intensive Care Unit 9 0 % 9 6 % 4 2 % 0 % 0 % 0 % 1 9 % 1 0 0 % 0 % 0 % 0 % 0 % 0 %

MedStar Franklin Square Medical Center - ICU 1 0 % 4 6 % 2 3 % 0 % 0 % 0 % 0 % 0 % 0 % 0 % 0 % 0 % 0 %

MedStar St. Mary's Hospital - ICU 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 6 5 %

MedStar Union Memorial Hospital - CCU 1 0 0 % 1 0 0 % 9 7 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 7 7 % 8 3 % 1 0 0 % 1 3 %

Meritus Medical Center - 4 West Critical Care 1 0 0 % 1 0 0 % 1 0 0 % 9 7 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 2 6 %

Prince George's Hospital Center - ICU 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 6 3 % 3 2 % 1 0 0 % 1 0 0 % 2 9 % 0 % 0 % 0 %

Saint Agnes Hospital - AICU 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 0 % 0 % 0 % 0 %

Sinai Hospital of Baltimore - 4th Floor ICU 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 9 3 % 1 0 0 % 1 0 0 % 1 0 0 % 7 1 %

Suburban Hospital - ICU 3400 9 7 % 9 6 % 1 0 0 % 8 0 % 8 7 % 1 0 0 % 9 7 % 1 0 0 % 1 0 0 % 6 8 % 0 % 0 % 0 %

Suburban Hospital - ICUA 3100 8 1 % 1 0 0 % 4 2 % 3 0 % 7 7 % 4 3 % 9 7 % 9 4 % 9 7 % 2 3 % 0 % 0 % 0 %

Abington Memorial Hospital - 3T1&2 0 % 1 0 0 % 1 0 0 % 9 3 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 6 1 %

Abington Memorial Hospital - 3T3&4 0 % 9 3 % 9 7 % 9 3 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 6 1 %

Abington Memorial Hospital - MICU 0 % 9 6 % 9 7 % 8 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 9 7 % 6 1 %

Abington Memorial Hospital - WPCU/1W 0 % 9 6 % 1 0 0 % 9 3 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 9 0 % 1 0 0 % 1 0 0 % 8 4 % 6 1 %

Brandywine Hospital - ICU 1 8 % 5 2 % 0 % 0 % 0 % 0 % 0 % 0 % 0 % 0 % 0 % 0 %

Doylestown Hospital - ICU 3 % 3 2 % 3 5 % 1 0 % 0 % 0 % 0 % 3 % 0 % 1 9 % 3 % 0 % 0 %

Indiana Regional - ICU 0 % 0 % 0 % 0 % 0 % 1 0 0 % 1 0 0 % 9 4 % 8 3 % 0 % 0 % 0 % 0 %

Lower Bucks Hospital - ICU 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 0 %

Magee Rehabilitation - SCI 1 0 0 % 1 0 0 % 3 9 % 1 0 0 % 8 4 % 9 3 % 9 4 % 1 0 0 % 1 0 0 % 0 % 0 % 0 % 3 9 %

NPHS- St Josephs- ICU 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 9 7 % 9 7 % 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 6 %

NPHS- St Josephs- PICU 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 2 7 % 1 0 0 % 1 0 0 % 0 % 1 0 0 % 1 0 0 % 1 0 0 % 0 %

Troy - ICU Med/surg 0 % 0 % 6 5 % 6 3 % 6 8 % 8 0 % 1 0 0 % 1 0 0 % 1 0 0 % 9 0 % 1 0 0 % 9 0 % 0 %

Table 2: Completion Rates on Daily Process Measure Data Entry

Break from data collection

VAE Rates: VAC (Q2-Q4 2013)

19Figure 1 & Table 3: VAC Rate Per 1000 Ventilator Days

Q2 2013 Q3 2013 Q4 2013 P-value*(Q2 vs. Q4)

Aggregate 4.26 (77/18077)

4.74 (61/12871)

2.72 (16/5890)

0.116

MD 3.51 (40/11387)

5.56 (49/8810)

2.85 (12/4208)

0.639

PA 5.53 (37/6690)

2.95 (12/4061)

2.38 (4/1682)

0.118

Per 1000 Vent Days

VAE Rates: IVAC (Q2-Q4 2013)

20Figure 2 & Table 4: Total IVAC Rate Per 1000 Ventilator Days

Q2 2013 Q3 2013 Q4 2013 P-value*(Q2 vs. Q4)

Aggregate 3.04(55/18077)

3.26 (42/12871)

1.53 (9/5890)

0.058

MD 3.25(37/11387)

3.18(28/8810)

1.19 (5/4208)

0.035

PA 2.69 (18/6690)

3.45 (14/4061)

2.38 (4/1682)

1.000

VAE Rates: VAP [PoVAP + PrVAP]

(Q2-Q4 2013)

21Figure 3 &Table 5: Total VAP Rate Per 1000 Ventilator Days

Q2 2013 Q3 2013 Q4 2013 P-value*(Q2 vs. Q4)

Aggregate 1.38(25/18077)

1.40 (18/12871)

0.68 (4/5890)

0.202

MD 1.49(17/11387)

1.36(12/8810)

0.48 (2/4208)

0.125

PA 1.20 (8/6690)

1.48 (6/4061)

1.19 (2/1682)

1.000

Completion Rate: VAE Rate Registry Data (Q2–Q4 2013)

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Q2 2013 Q3 2013 Q4 2013

Aggregate 100% 88% 53%

MD 100% 86% 54%

PA 100% 90% 51%

Proportion of months with VAE data

Figure 4 & Table 6 : Total VAP Rate Per 1000 Ventilator Days

Structural Assessment: Oct. 2012 – Jan. 2013 (n=36)

Baseline •MD = 21 units (58.3%) •PA = 15 units (41.7%)

Results Reported•31.4% changing their ventilator circuits routinely

•60% changing their suctioning systems routinely

•85.3% used the orotracheal route for elective intubation in absence of difficult airway

•85.3% used a closed suction system with endotracheal tubes

•97.1% have policies for using precautions when suctioning, with 88.9% using these elements

•91.2% have policies for using hand hygiene, with 86.1% using these elements

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Structural Assessment: Oct. 2012 – Jan. 2013 (n=36)

Results Reported•13.9% used prophylactic IV antibiotics for VAP

•70.6% used policies against non-essential tracheal suctioning, with 16.7% using these elements

•94.1% used policies against supine positioning, with 16.7% using these elements

•67.7% have policies against gastric over-distention, with 0% occurrence

•71.9% had policies regarding performing condensate draining, with 41.7% using these elements

•57.1% used noninvasive ventilation, 44.1% had policies promoting its use

•33.3% used early mobility, 41.2% had policies promoting its use

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Exposure Receipt Assessment Pilot

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• Evaluates the penetrance of the CUSP and VAP interventions to front-line staff

• Anonymous assessment

• Completed by staff with direct patient care on the unit for only one shift

• Piloted by 5 teams in MD and PA

• Results divided into 4 domains:1. Response Rate on Assessment2. Distribution of Participants3. CUSP Components4. VAP Components

Exposure Receipt Assessment Pilot: Familiarity with CUSP Components (Nov. 2013)

26Figure 5: Reported Familiarity with CUSP Components of Intervention

Exposure Receipt Assessment Pilot: Training on VAP Toolkit (Nov. 2013)

27Figure 6: Reported Training on VAP Prevention Toolkit in Unit

Quarterly Interviews:Frequent Barriers to Progress (Q1 2013)

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Table 7. Barriers Reported as Being Frequent or Always

All units (N=43) MD units (N=23) PA units (N=20)

Barrier Percent of Units Barrier Percent

of Units Barrier Percent of Units

Competing priorities 58.1 Competing priorities 47.8 Competing priorities 70.0

Data collection burden 48.8 Data collection burden 43.5 Data collection burden 55.0

Not enough time 39.5 Not enough time 39.1 Staff turnover on unit 45.0

Data system problems 32.6 Data system problems 26.1 Confusion on CUSP 40.0

Staff turnover on unit 27.9 Leader support - exec 13.0 Not enough time 40.0

Leader support - MDs 18.6 Leader support - MDs 13.0 Data system problems 40.0

Confusion on CUSP 18.6 Staff turnover on unit 13.0 Leader support - MDs 25.0

Poor buy-in - MD staff 16.3 Knowledge of evidence 8.7 Turnover CUSP team 25.0

Turnover CUSP team 14.0 Poor buy-in - MD staff 8.7 Poor buy-in - MD staff 25.0

REPORTS SUMMARY 2013

• Highlights from of several assessments – including Summary Reports (Process Measure Data), VAE Rates,

Structural Assessment, Exposure Receipt Assessment Pilot, Quarterly Interviews

• Your Unit’s reports are available on CECity platform

• Can be utilized for- Increasing communication with your team members and front-line staff- Illustrating your unit’s progress to your senior executive partner- Sharing your performance and progress on VAE prevention with your

hospital administrators

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Your work makes a difference!

CUSP4MVP-VAP National Project Overview

MD and PA Work Influenced the CUSP4MVP-VAP National Project

• Based on your feedback

– Changing approach for incorporating CUSP into our QI

project

– Revising tools (i.e. quarterly interview, early mobility pilot,

exposure receipt assessment pilot)

– Including objective outcome measures

– Focus on sedation and delirium management

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CUSP4MVP-VAP: Participating CEs

• Coordinating Entities (CEs) for Cohort 1 of CUSP4MVP-VAP National Project

• Iowa• Michigan • New Jersey• Oklahoma • Pennsylvania• South Carolina• Tennessee• Texas• UHC

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CUSP4MVP-VAP: MD and PA Opportunities

• MD and PA opportunities with National Project:

- Joining National Project content calls for continued

education on CUSP and VAE prevention

- Share your experience on content/coaching calls:

• as implementation experts

• to discuss implementation successes and barriers

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CUSP4MVP-VAP: Content Call Schedule

Date: First Tuesday of every month (* Please note that this call does not follow the regular content call schedule)

Time: 2pm EST

Webinar Link: CUSP4MVP-VAP Content Calls

Call-in Information: 1-877-668-4493; Access code: 667 844 66534

Date Call Type and Module # Topic

February 5, 2014* Content Call, Module 1 CUSP 4 MVP-VAP Kickoff Webinar

February 18, 2014* Content Call, Module 2 Science of Safety & Identifying Defects

March 4, 2014 Content Call, Module 3

Pain, Agitation, and Delirium (PAD) - Delirium and Sedation Management

March 18, 2014* Content Call,

Module 4 PAD – Spontaneous Awakening Trials (SAT) and Spontaneous Breathing Trials (SBT)

April 1, 2014 Content Call, Module 5 Daily Early Mobility Overview

May 6, 2014 Content Call, Module 6

How to run a CUSP Team (Engaging all members of the CUSP team)

June 3, 2014 Content Call, Module 7 Daily Goals Facilitates VAE Prevention

July 1, 2014 Content Call, Module 8

Learning from Defects

Additional Resources

• Society for Critical Care Medicine ICU Liberation Group– http://www.iculiberation.org/Pages/default.aspx

• AHRQ CUSP Toolkit– http://www.ahrq.gov/professionals/education/curriculum-

tools/cusptoolkit/

• Armstrong Institute CUSP Tools– http://www.hopkinsmedicine.org/armstrong_institute/

training_services/cusp_offerings/cusp_guidance.html

• Armstrong Institute Training Opportunities– http://www.hopkinsmedicine.org/armstrong_institute/

training_services/cusp_offerings/

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Next Steps

Next Steps

• Collect Early Mobility data (January – March)

• Complete Exposure Receipt Assessment (February)

• Complete 2nd HSOPS (March)

• Begin data collection sampling strategy between process

measures and early mobility (April)

• Begin data collection for Low Tidal Volume Ventilation

measure (August)

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Data Collection Sampling Strategy: Begins April 1st

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2014 CUSP for VAP Data Collection Calendar

January

February

March

April

S M T W T F S

S M T W T F S

S M T W T F S

S M T W T F S

1 2 3 4

1

1

1 2 3 4 5

5 6 7 8 9 10 11

2 3 4 5 6 7 8

2 3 4 5 6 7 8

6 7 8 9 10 11 12

12 13 14 15 16 17 18

9 10 11 12 13 14 15

9 10 11 12 13 14 15

13 14 15 16 17 18 19

19 20 21 22 23 24 25

16 17 18 19 20 21 22

16 17 18 19 20 21 22

20 21 22 23 24 25 26

26 27 28 29 30 31

23 24 25 26 27 28

23 24 25 26 27 28 29

27 28 29 30

30 31

May

June

July

August

S M T W T F S

S M T W T F S

S M T W T F S

S M T W T F S

1 2 3

1 2 3 4 5 6 7

1 2 3 4 5

1 2

4 5 6 7 8 9 10

8 9 10 11 12 13 14

6 7 8 9 10 11 12

3 4 5 6 7 8 9

11 12 13 14 15 16 17

15 16 17 18 19 20 21

13 14 15 16 17 18 19

10 11 12 13 14 15 16

18 19 20 21 22 23 24

22 23 24 25 26 27 28

20 21 22 23 24 25 26

17 18 19 20 21 22 23

25 26 27 28 29 30 31

29 30

27 28 29 30 31

24 25 26 27 28 29 30

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September

October

November

December

S M T W T F S

S M T W T F S

S M T W T F S

S M T W T F S

1 2 3 4 5 6

1 2 3 4

1

1 2 3 4 5 6

7 8 9 10 11 12 13

5 6 7 8 9 10 11

2 3 4 5 6 7 8

7 8 9 10 11 12 13

14 15 16 17 18 19 20

12 13 14 15 16 17 18

9 10 11 12 13 14 15

14 15 16 17 18 19 20

21 22 23 24 25 26 27

19 20 21 22 23 24 25

16 17 18 19 20 21 22

21 22 23 24 25 26 27

28 29 30

26 27 28 29 30 31

23 24 25 26 27 28 29

28 29 30 31

Key: Process Measure data collection Early Mobility data collection No data collection; use this time to catch up on missing Process Measure and Early Mobility data

Enhancing Support for MD and PA Teams

• Objective Outcome Data - Armstrong will analyze your data for outcome measures if you provide it– decreasing duration of mechanical ventilation– decreasing hospital length of stay– decreasing mortality

• How do we enhance horizontal learning?

• What can the AI/MHA/HAP team do to better support you?

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Thank You

A sincere

THANK YOU

for all of your effort

and hard work to

reduce the incidence of VAP

in your units

and prevent HAIs!

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CUSP for VAP: Year in Review

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