CUSP 4 MVP – VAP Improving Care for Mechanically Ventilated Patients Data Webinar 1: Strategies for Collecting and Entering Daily Care Process Measures,

CUSP 4 MVP – VAP Improving Care for Mechanically Ventilated Patients Data Webinar 1: Strategies for Collecting and Entering Daily Care Process Measures, Structural Assessment, and Hospital Survey on Patient Safety Culture ARMSTRONG INSTITUTE FOR PATIENT SAFETY AND QUALITY Johns Hopkins University January 7, 2015

CUSP 4 MVP - VAP Comprehensive Unit-based Safety Program for Mechanically Ventilated Patients and Ventilator-Associated Pneumonia

Daily Care Process Measures Review Kathleen Speck, MPH
CUSP 4 MVP – VAP Improving Care for Mechanically Ventilated Patients

Administrative Announcements
Webinar access information: events/onstage/g.php?t=a&d= Call in details Dial: Use code: Presentation slides and recording will be available on the project website

Polling Question Who is on the call? IP – infection preventionist
RN – registered nurse RT – respiratory therapist PT – physical therapist OT – occupational therapist MD - physician Healthcare executive Educator National project team Other

Objectives Review the definitions for Daily Care Process Measures, Structural Assessment and HSOPS Review the web-based portal Review how to enter Daily Care Process Measure and Structural Assessment data Review how to administer HSOPS at your site

2014 SHEA Compendium Update1
Elevate the head of the bed 30-45° Provide endotracheal tubes with subglottic secretion drainage ports for patients likely to require more than 48 or 72 hours of intubation Manage ventilated patients without sedatives whenever possible

2014 SHEA Compendium Update1
Interrupt sedation once a day (spontaneous awakening trials) Assess readiness to extubate once a day (spontaneous breathing trials) Pair spontaneous breathing trials with spontaneous awakening trials Employ early exercise and mobilization Use non-invasive positive pressure ventilation (NIPPV) whenever feasible

2013 Society of Critical Care Medicine PAD Guidelines2
Establish an overarching protocolized approach to daily ICU patient management using Pain, Agitation, and Delirium (PAD) Guidelines Assess and treat pain first (may be sufficient) If patient remains agitated after adequately treating pain Start with PRN bolus sedation (as needed) Use continuous sedation if boluses exceed 3 per hour Avoid benzodiazepines in most patients

2013 Society of Critical Care Medicine PAD Guidelines2
Interrupt sedation daily If necessary, restart at lowest dose to maintain chosen target level of consciousness Avoid deep sedation (RASS -4/-5) as it appears harmful; instead, target awake or alert Screen for delirium (CAM-ICU or ICDSC) If delirious, first seek reversible causes and attempt non-pharmacologic management Use the ABCDE’s to improve outcomes for your patients Turn off sedation daily and restart only if needed at lowest dose to maintain chosen target level of consciousness Deep sedation (RASS -4/-5) appears harmful; target awake/alert Screen for delirium (CAM-ICU or ICDSC); If delirious, first seek reversible causes and attempt non-pharmacologic management Use the ABCDEs to improve outcomes for your patients

What Is the Evidence? Tune in to the content webinars for evidence supporting each intervention Content webinars are 90 minutes and occur on the third Wednesday of each month from 11:00 am EST DATE TOPIC Jan 21, 2015 Science of Safety & Identifying Defects Pain, Agitation, and Delirium (PAD) and Sedation Management Feb 18, 2015 Spontaneous Awakening Trials (SAT) and Spontaneous Breathing Trials (SBT) Utility of the Exposure Receipt Assessment Mar 18, 2015 Delirium Assessment Training Benefits of Subglottic Endotracheal Tubes

What Is the Evidence? Tune in to these Infection Prevention webinars for training on the importance and details of ventilator-associated events IP webinars are 60 minutes and occur on the fourth Wednesday in January, February and March at 11:00 am EST DATE TOPIC Jan 28, 2015 VAE Surveillance Training: An Overview Feb 25, 2015 VAE Surveillance Training: Infection-related Ventilator-associated Complication (IVAC) Mar 25, 2015 VAE Surveillance Training: Possible VAP (PoVAP) and Probably VAP (PrVAP)

“ In God we trust. All others bring data. – W. E. Deming ”

Daily Care Process Measures Data Collection Tool
Detailed Instructions We like to call it the DCPMDCT. Just kidding. Contraindications & Location Codes

Contraindications and Locations

Let’s Begin Fill Out For All Beds Track by bed, not by patient Include
Bed number Was the patient in that bed intubated or trached AND on mechanical ventilation at the time of observation Y = Yes N = No E = Empty bed

Date of Intubation Enter the date the patient was intubated
If the date is not available*, enter admission date (either to the unit or to the hospital, as appropriate) If the patient is extubated and re- intubated within 24 hours, use the original date *i.e., when from an outside institution

Sub-G ETT Y = Yes N = No C = Contraindicated
Does the patient have a subglottic endotracheal tube? Y = Yes N = No If your unit doesn’t use Sub-G ETTs, enter N C = Contraindicated If C, enter the contraindication code for this patient in the next column

Sub-G ETT Contraindications
Why a Sub-G ETT is contraindicated? Find the contraindications on the back or on page 2 of the tool Remember, enter ‘N’ if your unit does not use Sub-G ETTs

Location of Intubation
Enter the location code where the patient was intubated Find the locations on the back or on page 2 of the tool If you are using Sub-G ETTs on your unit, but the patient is admitted with a different type of ETT, this allows you to track where the patient came from

Location of Intubation
Where was the patient intubated? Find the locations on the back or on page 2 of the tool

Elevating the Head of Bed
Is the HOB elevated to an angle of ≥ 30° from the horizontal? Y = Yes N = No C = Contraindicated If contraindicated, choose the reason from the contraindications listed on page 2 of the tool

Head of Bed Contraindications
Why was placing the HOB at an angle of ≥ 30° from the horizontal contraindicated? Find the contraindications on the back or on page 2 of the tool

Sedation Scale 1st question
What sedation scale do you use on your unit? This question refers to your unit, not to this specific patient

Sedation Scale R = Richmond Agitation Sedation Scale (RASS)
S = Riker Sedation- Agitation Scale (SAS) NU = Unit uses neither RASS or SAS If NU, skip to Delirium Assessment

Sedation Scale Choose either RASS or SAS, but not both
Choose the value closest to 10:00 am If equidistant, choose the earlier time

Sedation Scale: Target RASS
If you use ‘RASS’… Target: What is the target RASS score for this patient? Enter RASS sedation scale value (-5 to 4) ‘NS’ means not set ‘NK’ means target RASS was set, but is not known Enter ‘NK’ if you don’t know whether a target RASS was actually set

Sedation Scale: Actual RASS
If you use ‘RASS’… Actual: What is the actual RASS score for this patient? Enter RASS sedation scale value (-5 to 4) Enter ‘X’ if an actual RASS sedation level was not scored Enter ‘NK’ if target RASS was scored, but is not known Enter ‘NK’ if you don’t know whether a target RASS was actually scored

Sedation Scale: Target SAS
If you use ‘SAS’… Target: What is the target SAS score for this patient? Enter SAS sedation scale value (1 to 7) Enter ‘NS’ if not set Enter ‘NK’ if target SAS was set but is not known Enter ‘NK’ if you don’t know whether a target SAS was actually set

Sedation Scale: Actual SAS
If you use ‘SAS’… Actual: What is the actual SAS score for this patient? Enter SAS sedation scale value (1 to 7) Enter ‘X’ if an actual SAS sedation level was not scored Enter ‘NK’ if target SAS was scored, but is not known Enter ‘NK’ if you don’t know whether a target SAS was actually scored

Sedation Scale: NU NU = Unit uses neither RASS or SAS
If you entered ‘NU’ NU = Unit uses neither RASS or SAS If NU, skip Target and Actual sections and go to Delirium Assessment

Delirium Assessment C = Confusion Assessment Method for the ICU (CAM-ICU) A = Attention Screening Exam (ASE) NU = Unit uses neither CAM-ICU or ASE If NU, skip to SAT

Attention Screening Exam (ASE)
If the CAM-ICU is not yet feasible in your unit, we recommend that patients at least undergo the ASE once per nursing shift The ASE is feature 2 of the CAM-ICU and this second test of attention is the cardinal feature of a delirium diagnosis

Delirium Assessment Choose either CAM- ICU or ASE, not both
CAM-ICU incorporates the ASE Choose the value closest to 10:00 a.m. If equidistant, choose the earlier time

Confusion Assessment Method for the ICU (CAM-ICU)
Society of Critical Care Medicine’s 2013 Pain, Agitation, and Delirium (PAD) clinical practice guidelines Recommends theses valid and reliable delirium screening tools Confusion Assessment Method for the ICU (CAM-ICU) Intensive Care Delirium Screening Checklist (ICDSC) Screen moderate to high risk patients at least once per nursing shift

Delirium Assessment CAM-ICU
Is the patient positive or negative for delirium? Enter ‘P’ if the patient is positive for delirium Enter ‘N’ if the patient is negative for delirium Enter ‘UTA’ if unable to assess Such as RASS = -4 or -5 OR SAS = 1 or 2 Enter ‘X’ if CAM-ICU assessment was not completed Enter ‘NK’ if CAM-ICU was completed, but results aren’t known Enter ‘NK’ if you don’t know whether the exam was performed

Determine if patient can follow a simple command (pay attention) for seconds Recognize inattention as the cardinal feature of delirium that must be present for diagnosis For centers not using the full CAM-ICU, conducting the ASE is a good barometer of the presence or absence of delirium May yield abnormal results due to disease, drugs or other causes

Provider reads one of the following sequences: S A V E A H A A R T C A S A B L A N C A A B A D B A D D A Y Patient squeezes the provider’s hand when he hears the letter ‘A’ Error defined as No squeeze with letter ‘A’ A squeeze on a letter other than ‘A’

Count the number of errors Inattention is present if the patient commits more than 2 errors If the patient squeezes on every letter, assign an error count of 10 If the patient doesn’t squeeze on any letter, assign an error count of 10

What is the patient’s ability to pay attention? Use only if CAM-ICU is not performed Enter the number of errors, 0 to 10 Enter ‘UTA’ if unable to assess RASS = -4 or -5 SAS = 1 or 2 Enter ‘X’ if the exam was not performed Enter ‘NK’ if the exam was performed, but number of errors is not known Enter ‘NK’ if you don’t know whether the exam was performed

Spontaneous Awakening Trial (SAT)
Has the patient had a Spontaneous Awakening Trial today?

Enter ‘NS’ if the patient is not sedated Enter ‘Y’ if medications for sedation have been held today Enter ‘N’ if medications for sedation have NOT been held today Enter ‘C/NI’ if holding medications for sedation is either contraindicated or not indicated today If ‘C/NI’ go to next column labeled “Reason SAT Contraindic”

Spontaneous Awakening Trial (SAT) Contraindications
Why is an SAT inappropriate for this patient? Find the contraindications on the back or on page 2 of the tool

Spontaneous Breathing Trial (SBT)
Has the patient had a spontaneous breathing trial today?

Remove ventilator support Allow patient to breathe With either a T-tube circuit Or with a ventilator circuit With low levels of PS (5–8 cm H2O in adults) With or without 5 cm H2O PEEP No changes are required in FiO2 or the level of PEEP

Enter ‘Y’ if the patient had an SBT Enter ‘N’ if the patient did not have an SBT Enter ‘C/NI’ if the use of an SBT is contraindicated/not indicated If ‘C/NI’, go to Reason SBT Contraindic

Spontaneous Breathing Trials Contraindications (SBT)
What is the reason an SBT is inappropriate for this patient? Find the contraindications on the back or on page 2 of the tool

Spontaneous Breathing Trial (SBT) with Sedatives Off
Was the SBT performed with the sedatives off? Sedatives are considered off: During an SAT If sedative infusion is stopped If standing order for intermittent sedating meds is held or cancelled If the interval between standing doses is extended

Data Collection Scenarios

Collecting Daily Care Process Measures
Who should collect this data? Nurse Nurse educator Respiratory therapist How often should this data be collected? Daily How often should this data be entered in the data portal? Weekly As with any new process, it takes some time to find where to extract the data for each field. Once the process is established, it becomes easier and takes less time.

1st 2nd Data Source Data Entry Method Bedside Paper tool Direct Portal Entry Charts Spreadsheet Template Upload into Portal EMR Workstation or Mobile Device

Scenario 1: Bedside Observe the collected measures at the bedside Enter data directly into the project data entry portal via mobile computing device Bedside Mobile Device Direct Portal Entry

Scenario 2: Patient charts Review physical patient charts Identify the fields for each of the daily care process measures Record data on data collection tool Enter data into the project data portal Charts Paper Tool Direct Portal Entry

Scenario 3: Electronic medical records Access the electronic medical records Identify the fields for each of the daily care process measures Note data on a data collection tool Enter data into the spreadsheet template Upload spreadsheet into project data entry portal EMR Paper Tool Spreadsheet Template

Tara’s Daily Process and Portal Navigation Tutorial

Tools that Focus on Eliminating Ventilator- Associated Pneumonia
CUSP4MVP-VAP Home Page Tools that Focus on Eliminating Ventilator- Associated Pneumonia

Networks Admins vs Members Member’s Permissions Enter data into the CUSP4MVP-VAP tools View reports from the CUSP4MVP-VAP Daily Care Process Measures Tool Administrator’s Permissions Administrators have all the functionality of members and can also: Invite users to participate into the Network View the Network Performance Monitor Send out HSOPS invitations View HSOPS reports Members or Administrators can be part of many Networks There can be multiple administrators within a Network Networks and their hierarchy are configured by Armstrong Institute

You will be prompted to login before accessing this page
My Projects Shows all the available projects and will highlight the one(s) you are participating in You will be prompted to login before accessing this page Clicking on the project will take you to the CUSPMVP-VAP Project page Mary Schmidt

CUSP4MVP-VAP My Tools Page Ability to Search by Tool
Mary Schmidt CUSP4MVP-VAP Test Network Ability to Search by Tool Allows you to quickly access various tools your network(s) are registered for. Coordinating Entities will have the ability to view Tools registered to their Children networks. Tool Name Search by Tool Name or by Network Name Network which Data will be Entered for

Network Admins see the Manage or Register Button
Viewing for Community Memorial WICU as Mary Schmidt Network Admins see the Manage or Register Button Displays the Network entering data. Ability to click on network name to navigate to network CUSP4MVP-VAP Project Page Manage/View CUSP4MVP-VAP National Tools Displays your data entry tools Your access to a tool is determined by your role - whether you are a member or an administrator. For example, only administrators will see the “Manage” button for HSOPS.

Shows all the Networks that you are associated with
My Networks View Networks Mary Schmidt Shows all the Networks that you are associated with Ability to search by name of Network

CUSP4MVP-VAP Project Page
Mary Schmidt The first time entering the page, you’ll see the “Register” button Please note, apps that aren’t yet launched will display with “Coming Soon” Once registration is complete, the button will change to display “Manage” Viewing for Community Memorial WICU as Mary Schmidt

CUSP4MVP-VAP Registration
Community Memorial WICU The first time accessing the Daily Care Process Measures app, the following registration information will be required.

Daily Care Process Measures Add New Event
Enter data by accessing the Events Tab Sort previous entries by Column Titles Sort by Filter Criteria as well Ability to Edit or Delete entries

Daily Care Process Measures – Data Entry
Data entry grid opens in modal overlay. Date validation enabled on form.

Help icons available for each data entry field.

Is ‘HOB’ at or over thirty degrees from the horizontal?
Daily Care Process Measures – Data Entry Enter ‘HOB’ criteria. All fields are enabled with validation Is ‘HOB’ at or over thirty degrees from the horizontal? If not, why?

Enter ‘RASS’ if unit uses Richmond Agitation Sedation Scale Enter ‘SAS’ if unit uses Riker Sedation-Agitation Scale Enter ‘NU’ if not sedation scale is in use, or uses a scale other than RASS or SAS. If ‘NU’ is entered, skip to the ‘Delirium Assessment’ column. Don’t enter info into ‘Target’ or ‘Actual’

Structural Assessment Review

Structural Assessment
Who should collect this data? Unit lead How often should this data be collected and entered into the data portal? Semi-annually How long does it take to complete? About ten minutes

Semi-Annual Structural Assessment
Please answer the following questions regarding your ICU. For intubated/trached patients, how often do you change the ventilator circuit? Not routinely changed unless soiled or malfunctioning Routinely changed at regular interval; please specify in days ____ When used, how often do you change the closed endotracheal suction system? It is not used in this ICU

In the absence of a difficult airway, how often is an orotracheal route used for elective intubation in your ICU? For patients receiving mechanical ventilation via an endotracheal tube, how often is a closed endotracheal suction system used in your ICU? When mechanical ventilation is required, how often are prophylactic intravenous antibiotics used to prevent ventilator-associated pneumonia in your ICU? In your ICU, how often are patients placed in a supine (flat) position, when there is no contraindication? In your ICU, how often are standard precautions used while suctioning the respiratory tract?

In your ICU, how often is tracheal suctioning performed when it is not clinically indicated? In your ICU, how often are mechanically ventilated patients experiencing gastric over-distention? In your ICU, how often is condensate drained away from the patient while the circuit remains closed? In your ICU, how often do healthcare providers perform hand hygiene before contact with respiratory equipment? How often is noninvasive ventilation used in your ICU? In your ICU, how often is an early mobility protocol used for patients receiving mechanical ventilation?

Regarding your written ICU, nursing and/or respiratory therapy policies and procedures concerning patients receiving mechanical ventilation, is there guidance to: (YES/NO) Avoid supine (flat) patient positioning unless clinically indicated (i.e. hemodynamic instability, orthopedic injury, etc.)? Use standard precautions while suctioning the respiratory tract secretions? Avoid nonessential tracheal suctioning? Avoid gastric over distention? Periodically remove condensate from circuits? Assure that circuits are closed during removal of condensate to assure that condensate doesn’t drain toward the patient? Perform hand hygiene before contact with respiratory equipment?

Does your ICU actively promote: (YES/NO) Use of noninvasive ventilation protocol? Early mobility protocol for patients receiving mechanical ventilation?

Next Steps Where will you find your data?
Look for data sources Make plans for data collection processes Practice collecting data for next call After finding your data sources and starting data collection: Collect data daily Enter the data at least weekly

Tara’s Structural Assessment Tutorial

CUSP 4 MVP – VAP Improving Care for Mechanically Ventilated Patients
HSOPS Review CUSP 4 MVP – VAP Improving Care for Mechanically Ventilated Patients

What Is HSOPS? Hospital Survey On Patient Safety Culture (HSOPS)
Measures safety culture within the clinical units of hospital Part of a suite of survey tools (SOPS) for hospitals, medical offices, and nursing homes Sponsored by Agency for Healthcare Research & Quality (AHRQ) HSOPS App: online survey tool Developed by the Armstrong Institute in partnership with CeCity Allows participants to complete the HSOPSsurvey online Provides detailed reports for survey coordinators to debrief clinical areas

HSOPS Sample Questions
10 COMPOSITE SCORES (DIMENSIONS) SAMPLE QUESTION Supervisor/manager expectations & actions promoting patient safety B1. My supervisor/manager seriously considers staff suggestions for improving patient safety. Organizational learning-continuous improvement A9. Mistakes have led to positive changes here. Teamwork within unit A1. People support one another in this unit. Communication openness C4. Staff feel free to question the decisions or actions of those with more authority. Feedback & communication about error C1. We are given feedback about changes put into place based on event reports.

Timeline of Key HSOPS Tasks
PHASE TASK PREP (~3 WKS) WK1 WK2 WK3 WK4 WK5 WK6 WK7 WK8 WK 9 Planning Stage Logistical tasks Who will administer? Who will be surveyed? Publicize! Motivate participation Create a debriefing plan Alert Participants Provide pre-notification (post, , meetings) Upload Unit Data Enter unit background info Start! Upload participant addresses or previously collected data

Timeline of Key HSOPS Tasks
PHASE TASK PREP (~3 WKS) WK1 WK2 WK3 WK4 WK5 WK6 WK7 WK8 WK 9 Track Monitor response rates Target > 60% Remind 1st reminder Remind Again Final reminder End The Survey Close the survey Collect Data Download results report Execute Debrief & plan improvements

HSOPS for your unit HSOPS coordinator responsibilities
Coordinate with hospital and clinical area leadership Participate in or review training Use the online database Support participants Enter data about your clinical area Monitor response rate Distribute information and materials Make sure your list is up to date, check for: Staff on administrative or extended sick leave, Staff who appear in more than one staffing category or hospital area/unit, Staff who have moved to another hospital area/unit, Staff who no longer work at the hospital, and Other changes that may affect the accuracy of your list addresses Set a goal – needs to be at least 60% Make a plan Display fliers and posters Provide incentives

Tara’s HSOPS Tutorial CUSP 4 MVP – VAP Improving Care for Mechanically Ventilated Patients

CUSP4MVP-VAP HSOPS New Data Collection Cycle Notification When Armstrong opens a new cycle for data collection for HSOPS, the Network Administrators will receive an notification. Network Administrators can click the link in the to start administering the survey. The link in the will direct Network Administrators directly to the My Tools Page.

CUSP4MVP-VAP Project Page
Viewing for CUSP4MVP-VAP as Mary Schmidt Mary Schmidt CUSP4MVP-VAP Project Page Displays the Network entering data Manage/View CUSP4MVP-VAP National Tools Displays your data entry tools Your access to a tool is determined by your role - whether you are a member or an administrator. For example, only administrators will see the “Manage” button for HSOPS. Tools which are still in development are indicated with a “Coming Soon” banner Network Admins see the Manage Button

Survey Administration
From this page you can Upload Responses, Send Invitations and Track Completions Viewing for CUSP4MVP-VAP Test as Mary Schmidt

When Upload Responses is selected, HSOPS results collected outside of the site in the AHRQ format can be uploaded on the following screen: Viewing for CUSP4MVP-VAP Test as Mary Schmidt

When the date fields are entered, select Upload Responses and the following screen will be displayed:

You can also visit the Upload Responses page by selecting the View Upload Queue hyperlink.
Viewing for CUSP4MVP-VAP Test as Mary Schmidt

Enter the Total Participants by clicking on the Edit Pencil Icon

Note the Total Participants number has been updated:

Participants can be invited by uploading a spreadsheet of addresses, or typing the addresses in the field. Unique survey links are ed to each invitee. Viewing for CUSP4MVP-VAP Test as Mary Schmidt Please note, when uploading a spreadsheet of addresses, be careful of formatting issues such as “spaces” or special characters.

As Participants are notified, the value updates in the table:

To see an example spreadsheet select the first HERE hyperlink

If participants DO NOT have email addresses, select the second HERE hyperlink.

See Participant view of the survey below:

As Participants complete the survey, Administrators can track the status, as updates display on the interface: Viewing for CUSP4MVP-VAP Test as Mary Schmidt

If you decide to add more participants later, click on Upload Responses or Send s, and add the participants. After additional participants have been invited, or additional upload responses have been added, please note the status is updated, please see Total Notified:

Remember to update the Total Participants, to match the Total Notified
Remember to update the Total Participants, to match the Total Notified. Note the Response Rate calculates accordingly. Viewing for CUSP4MVP-VAP Test as Mary Schmidt

To Remove Notified Participants, click on the icon
Pencil Icon next to edit the Total Notified. On the Remove Notified Participants pop-up box, select the Participant you wish to remove by selecting the box next to the address. This will update the number in the Total Notified column. Make sure you update the Total Participants to match the Total Notified column. Only participants who have not yet completed the survey can be removed.

When the survey time period ends, the survey will be closed out
When the survey time period ends, the survey will be closed out. Remember to monitor the page for response rates, and send follow up reminders to your team, to reach a minimum of a 60% response rate. Viewing for CUSP4MVP-VAP Test as Mary Schmidt

When the Survey is closed, Reports will be available for download the next day.

Data Available in Variety of Aggregate Reports in PDF Format
HSOPS App Reports Data Available in Variety of Aggregate Reports in PDF Format

Next Steps CUSP 4 MVP – VAP Improving Care for Mechanically Ventilated Patients

Next Steps: Homework Review and improve data collection strategies.
Begin entering data into the CUSP 4 MVP- VAP data portal Daily Process Measures Structural Assessment Hospital Survey on Patient Safety (HSOPS)

Next Content Webinar: Science of Safety and Identifying Defects | Pain, Agitation, and Delirium (PAD) and Sedation Management January 21, :00 AM to 12:30 PM EDT Educate frontline staff and executive partners on the science of safety. Administer the SSA and collate staff responses. Realize the importance of managing patients’ pain, agitation, and delirium. Demonstrate the relationship between PAD management and outcomes related to mechanical ventilation.

Mark Your Calendar: Upcoming Sessions
DATE WEBINAR TYPE AND # TOPIC Jan 21, 2015 11AM to 12:30PM EST Content Webinar 1 Science of Safety & Identifying Defects Pain, Agitation, and Delirium (PAD) and Sedation Management Jan 28, 2015 11AM to 12PM EST IP VAE Surveillance Training: An Overview Feb 4, 2015 Data Webinar 2 How to Complete the Exposure Receipt Assessment Preliminary Structural Assessment Data Reports

CUSP4MVP–VAP Website Visit:

What Can I Find on the CUSP 4 MVP – VAP Website?
Education materials Toolkits CUSP Daily Process Measures Early Mobility Low Tidal Volume Ventilation (soon) Literature Reviews Fast Fact Sheets CUSP Tools and Guides Archive of webinars led by subject matter experts

References ARMSTRONG INSTITUTE
Klompas M, Branson R, Eichenwald EC, Greene LR, Howell MD, Lee G, Magill SS, Maragakis LL, Priebe GP, Speck K, Yokoe DS, Berenholtz SM. Strategies to prevent ventilator-associated pneumonia in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014;35(8): PMID: Barr J, Fraser GL, Puntillo K, Ely EW, Gélinas C, Dasta JF, Davidson JE, Devlin JW, Kress JP, Joffe AM, Coursin DB, Herr DL, Tung A, Robinson BR, Fontaine DK, Ramsay MA, Riker RR, Sessler CN, Pun B, Skrobik Y, Jaeschke R; American College of Critical Care Medicine. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med Jan;41(1): PMID: ARMSTRONG INSTITUTE FOR PATIENT SAFETY AND QUALITY

CUSP 4 MVP – VAP Improving Care for Mechanically Ventilated Patients Data Webinar 1: Strategies for Collecting and Entering Daily Care Process Measures,

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CUSP 4 MVP – VAP Improving Care for Mechanically Ventilated Patients Data Webinar 1: Strategies for Collecting and Entering Daily Care Process Measures,

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