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Preventing Hospital Acquired Pneumonia (HAP) in Neuroscience Patients UCSF Center for Nursing Research and Innovation October 22, 2014 Presenters: Kathryn.

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Presentation on theme: "Preventing Hospital Acquired Pneumonia (HAP) in Neuroscience Patients UCSF Center for Nursing Research and Innovation October 22, 2014 Presenters: Kathryn."— Presentation transcript:

1 Preventing Hospital Acquired Pneumonia (HAP) in Neuroscience Patients UCSF Center for Nursing Research and Innovation October 22, 2014 Presenters: Kathryn Snow, RN, MS, CNS, CNRN Jacqueline Narkizian, RN, MSN 10/22/2014Kathryn Snow, RN, MS

2 Acknowledgements Cathy Parker, RN, Clinical Adult Services Director Nora Tam, Operations Specialist & Senior Staff Assistant Barbara VanAmburg, RN, Chief Nursing Officer Michelle Brown, Neuroscience Nurse Manager Mary Machanga, ICU Nurse Manager Staff Champions, ICU and Neuroscience Unit The Hospital and Emergency Department Reliability and Operational Excellence for Safety Committee (HEROES)– Kaiser Permanente Redwood City 10/22/2014 Kathryn Snow, RN, MS

3 Preventing HAP Purpose: To reduce Hospital Acquired Pneumonia by 15%. 10/22/2014Kathryn Snow, RN, MS 10/22/2014Kathryn Snow, RN, MS

4 Hospital Acquired Infections HAP C Difficile Surgical Site Central Line Associated Blood Stream Infection Catheter Associated Urinary Tract Infection 365 deaths21,900 days 2037 pts 110 deaths18,600 days 997 pts18 deaths5,184 days 83 pts 4 deaths395 days 163 pts 0 deaths234 days # Patients # Deaths # Attrib Pt Days # Patients with HAI/yr # Attributable deaths # Attributable Hosp Days 2,661 pts Preventing HAP – Background Data 10/22/2014 Kathryn Snow, RN, MS

5 Preventing HAP – Background Data Characteristics of 87% of Actual HAP Cases: Confused, obtunded or sedated NG or feeding tubes Low albumin Post-operative patients All commonplace for neuro patients 10/22/2014 Kathryn Snow, RN, MS 10/22/2014

6 Preventing HAP – 2013 Rate 10/22/2014Kathryn Snow, RN, MS 12.5 per 1K Patient Days

7 Risk Profile - Neuro Patients Airway obstruction  LOC Poor head position Poor cough / gag Poor control of saliva Poor muscle control / tone Airway edema Diagnoses: cervical surgery, craniotomy, diaphragm paralysis, stroke 10/22/2014Kathryn Snow, RN, MS

8 100% = 70 Stroke = 27 of % = 30 (12 at our hospital, 18 within 12 months) Preventing HAP – Case Attribution 10/22/2014Kathryn Snow, RN, MS

9 Preventing HAP – Case Attribution HAP 2013 SurgicalMed-Surg Unit 1 TelemetryMed-Surg Unit 2 ICUNeuroTotal Total Cases /22/2014Kathryn Snow, RN, MS

10 Observed Patterns Oral care inconsistent Mobility not a primary priority Incentive Spirometer Use inconsistent Nurses lacked confidence with naso-tracheal suctioning Aspects of tracheostomy care policy were not being followed Lack of awareness about HAP 10/22/2014Kathryn Snow, RN, MS

11 Observed Patterns Head of Bed ≥ 30° hard-wired Dysphagia screen Kaiser Permanente devised ROUTE Bundle for Medical-Surgical areas Concurrent project in ICU: Rethinking Critical Care 10/22/2014Kathryn Snow, RN, MS

12 ROUTE Bundle Kathryn Snow, RN, MS10/22/2014

13 Rethinking Critical Care Initiatives Delirium Assessment using Confusion Assessment Method (CAM-ICU) tool Daily Spontaneous Awakening and Spontaneous Breathing trials (SAT / SBT) for mechanically ventilated patients Mobility Protocol 10/22/2014 Kathryn Snow, RN, MS

14 Methods 2012, 4 th quarter, HAP Summit 2013 Interventions: Chlorhexidine rinse every twelve hours added to MAR ROUTE Bundle education initiated for medical-surgical units Tile markers placed in floor to encourage ambulation Standardized HAP Prevention order sets initiated Nasogastric tube policy changed to reflect order sets Ongoing tracking of ROUTE Bundle compliance by management and HEROES committee Multi-disciplinary Rounds 10/22/2014Kathryn Snow, RN, MS

15 Methods 2014 Interventions: HAP Prevention orders added to Stroke order sets Targeted education for the Neuroscience unit focusing on HAP statistics, ROUTE Bundle interventions, naso-tracheal suctioning technique and tracheostomy care ICU Nurses received HAP education as part of annual Stroke training Collaboration between RN, Neuroscience physician, and Respiratory Therapy teams to optimize respiratory treatment strategies 10/22/2014Kathryn Snow, RN, MS

16 Preventing HAP Results Jan-Aug 2013 Jan-Aug /22/2014Kathryn Snow, RN, MS YTD 45% Reduction

17 Preventing HAP - Results 37 HAP cases in 2014 (Jan-Aug) Based on Primary Diagnosis: Neurosurgery/Neurology service 11 cases (30%) Internal Medicine service 14 cases (38%) Surgical services 12 cases (32%) 72% Overall Reduction from /22/2014Kathryn Snow, RN, MS

18 Discussion and Clinical Implications Rethinking Critical Care initiatives coincided with HAP initiatives Majority of ICU patients flow to Neuro unit Standardized orders sets ensured compliance Multiple layers of reinforcement: nurse managers, educators, critical care and neuro physicians, HEROES committee, multi-disciplinary rounds 10/22/2014Kathryn Snow, RN, MS

19 Discussion and Clinical Implications Staff nurses drove program success Clinical Adult Services Director champions mobility Culture change has occurred 10/22/2014Kathryn Snow, RN, MS


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