Ventilator-Associated Events/Iatrogenic Delirium
The NYSPFP initiative to reduce Ventilator-Associated Events (VAE) and iatrogenic delirium is designed to assist hospitals in implementing strategies to improve outcomes for critical care patients. NYSPFP promotes evidence-based best practices, including delirium screening, medication management, early mobility, minimization of sedation, and a ventilator-associated pneumonia prevention bundle to reduce harm from VAE and iatrogenic delirium in the critical care setting.
Goal:
To reduce ventilator-associated events (VAE) and the incidence of iatrogenic delirium in critical care patients by 20% from a 2014 baseline.
Approach:
NYSPFP’s approach to achieving performance excellence is embedded in a dynamic set of guiding principles, designed to foster a culture of safety and continuous quality improvement. The following operationalizes the NYSPFP Guiding Principles to innovate, engage, integrate and hardwire best practices for the reduction of VAE in critical care units.
VAE: NYSPFP will promote compliance with the traditional ventilator-associated pneumonia and ventilator-associated pneumonia (VAP) and ventilator-associated events (VAE) prevention bundle elements, including:
- Head of bed (HOB) elevation of 30 degrees or more;
- Peptic ulcer disease (PUD) and deep venous thrombosis (DVT) prophylaxis
- Daily sedation "vacation"
- Implementation of enhanced activity and mobility protocols
- Achieving compliance with oral care protocols
- Regular evaluation of readiness to wean
- Reducing or eliminating sedation beyond weaning/daily sedation vacation
- Promotion of teamwork practices including multi-disciplinary rounds, daily goal sheets and protocols.
Delirium: NYSPFP’s approach to achieving compliance with iatrogenic delirium includes adherence to the clinical practice guidelines for the management of pain, agitation, and delirium (PAD) along with the integration and implementation of the following ABCDEF bundle elements:
- Assess, Prevent, and Manage Pain
- Both SAT and SBT
- Choice of Analgesia and Sedation
- Delirium: Assess, Prevent, and Manage
- Early Mobility and Exercise
- Family Engagement and Empowerment
Success Stories:
NYSPFP has posted quality improvement examples submitted by participating hospitals that demonstrate quantitative successes. Please click on the link below to access: