The ventilator-associated pneumonia as a tracer condition for quality and patient�s safety in the adult intensive care unit. A critical process analysis.

Objective: Evaluate the relation of nursing workload, evaluated by the Nursing Activities Score (NAS), with the occurrence of Ventilator-associated Pneumonia (VAP) in an Intensive Care Unit (ICU) and the impact of VAP on hospitalization costs.Methods: Retrospective cohort study in Adult ICU of a high complexity Brazilian university hospital. The profile, outcomes, costs, and daily NAS from patients were collected. We also proposed some workload indicators based on NAS daily evaluation.Results: The study included 195 patients, 27.17% diagnosed with VAP. VAP was more prevalent in patients diagnosed with trauma on admission. The total costs of care were higher for VAP patients. In all multivariate models tested were predictive for VAP: the patient's intubation that occurs in days prior of the ICU admission day (higher risk if occurs in days prior the ICU admission day) and ventilation time prior ICU (higher risk if higher time). We found others predictors, but these were dependent on the model tested. Additional risk predictors were tracheostomy, propofol use, neuromuscular blocker use and the higher NAS from admission. The protective factors found were the percentage of adequacy of the assignment based in NAS that measure if the workload measured by the NAS was offered and the increment in NAS during the ventilation time.Conclusions: The offering of an adequate nursing work scale (adequate number of professionals for the care), as a function of the nursing workload measured by the NAS, could be effective in the reduction of VAP, hospital stay time and hospital costs.

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Study of ventilator associated pneumonia in an adult intensive care unit of a tertiary care hospital

Journal of Patient Safety & Infection Control ◽

10.1016/j.jpsic.2015.10.121 ◽

2015 ◽

Vol 3 (2) ◽

pp. 86

Author(s):

A. Tolpadi ◽

S. Bhoite ◽

M. Modak

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Ventilator Associated Pneumonia ◽

Care Hospital ◽

Adult Intensive Care Unit

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Using Evidence and Process Improvement Strategies to Enhance Healthcare Outcomes for the Critically Ill: A Pilot Project

American Journal of Critical Care ◽

10.4037/ajcc2006.15.6.549 ◽

2006 ◽

Vol 15 (6) ◽

pp. 549-555 ◽

Cited By ~ 38

Author(s):

Carol W. Hatler ◽

Deanna Mast ◽

Jeannie Corderella ◽

Gina Mitchell ◽

Kathleen Howard ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Evidence Based Practice ◽

Care Delivery ◽

Bloodstream Infections ◽

Evidence Based ◽

Ventilator Associated Pneumonia ◽

Healthcare Outcomes ◽

Tertiary Referral Hospital ◽

Adult Intensive Care Unit

• Background Although the value of evidence-based practice may seem obvious, the process needed to produce more effective delivery of evidence-based healthcare is not obvious. Furthermore, the continuing escalation of healthcare costs fuels the desire of providers and consumers to undertake only those treatments that have benefit. One way to effect necessary changes in healthcare organizations is through focused, interdisciplinary, collaborative projects related to evidence-based practice. • Objectives To reduce rates of ventilator-associated pneumonia and catheter-related bloodstream infection in patients in the medical intensive care unit of a large, urban tertiary referral hospital in the Southwest. • Methods The theory of planned behavior served as the basis for providing staff members with research-based, easily controllable strategies that “fit” with the usual methods of care delivery. Implementation of the strategies and data collection were accomplished through routine rounds on patients and regular reporting of objective information. • Results During a 15-month period, use of the selected strategies resulted in a 54% reduction in ventilator-associated pneumonia, a 78% reduction in catheter-related bloodstream infections, and a 18% reduction in mean length of stay in the unit. Use of a multidisciplinary, environmentally tailored approach to concerns about patients’ care resulted in estimated cost savings of $1.0 million to $2.3 million. • Conclusions Early, consistent communication about the project’s rationale, expected behavior, and outcomes enhanced the manageability and effectiveness of this change in an adult intensive care unit.

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