AHA/HRET HEN 2.0
STORYBOARDS
ORGANIZATION AND TEAM
DEKALB REGIONAL MEDICAL CENTER:
FORT PAYNE, ALABAMA
PROJECT GOALS
IMPROVEMENT STRATEGIES
>> Prior to the start of the Hospital Engagement Network (HEN),
DeKalb identified an opportunity for improvement in ventilatorassociated conditions, specifically ventilator-associated
pneumonia (VAP)
INITIAL STRATEGIES:
>> Group analysis of data
>> Initial goals were to positively impact patient outcomes thus improving
patient and family satisfaction while reducing costs
++ Reducing length of stay
++ Reducing mortality and morbidity
>> Initially we made progress and now the goal is to maintain a rate of
zero which takes considerable time and staff training
>> Additionally, our goal is to engage frontline staff and secure buy-in
for ongoing improvement
>> Problem solved issues related to the commitment from
interdisciplinary front line staff and medical staff
++ We held face-to-face meetings to show the data, the “why” behind
what we were trying to achieve and to put a face to the initiative
• Reviewed medical records of the actual patients which gave
a “face” to our work and made the “why” much clearer which
resulted in heightened awareness and buy-in.
>> Medical staff leadership facilitated policy and process changes
>>
IMPROVEMENT STRATEGIES
RESULTS
RESULTS
ONGOING STRATEGIES:
>> Staff provided with evidenced-based clinical practice guidelines and
constant training
>> A rate of zero has been sustained for > 36 months
[(1) Evaluation Measures] Ventilator Associated Condition (VAC) — ALL Facilities
>> The lack of VAPs improved patient outcomes, reduced length of stay
and reduced mortality and morbidity
++ Sputum specimen obtained post-intubation to accurately identify
organisms, present on admission or intubation
>> Continued involvement of front-line staff and all disciplines positively
impacted employee morale, job satisfaction and buy-in
++ Elevation of head-of-bed
>> Positive results on the VAP initiative resulted in medical staff and
employee buy-in on other process improvement initiatives
++ Frequency of circuit change per clinical practice guidelines
++ Team work for oral care
++ Daily weaning trial and sedation vacation when patient meets criteria
++ Positioning of patient
>> Equipment and supplies modified to meet recommended practice
++ In-line suction catheters utilizing recommended frequency
of change
++ Use of in-line spacers for aerosolized medications
LESSONS LEARNED
SUSTAINABILITY AND SPREAD
>> Team meetings involving front-line staff are critical to achieve and
sustain the improvement
>> Front-line staff hardwired improvements by maintaining focus on the
initiatives and becoming champions to orient coworkers to process
changes
++ We continue to have quarterly team meetings
>> Staff must “own” the initiative
++ Staff want to do a great job and want their patients to have great
outcomes
>> Leaders have to be willing to invest time and resources in training
and retraining frontline staff and not be afraid to seek their input as
protocols and initiatives are developed
>> Empowering bedside caregivers to speak up and champion initiatives
was viewed as a positive move
++ Paved the way for other house-wide improvement initiatives
>> Collection, review and analysis of data demonstrates the improvement
has been sustained.
VENTILATOR BUNDLE CHECKLIST
VENTILATOR BUNDLE CHECKLIST
INDIVIDUAL PATIENT
ADMIT DATE:
VENT DATE:
1. HEAD OF THE BED AT 30 DEGREES
2. DAILY SEDATION VACATION OR
READINESS TO EXTUBATE
3. PUD PROPHYLAXIS
4. DVT PROPHLAXIS
PATIENT LABEL
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