1. It Takes a Village Contra Costa Regional Medical Center Stuart Forman, MD Kathryn Moore, OTR/L Ronald Marquez, PT Angela Bennett, RN Trent Tate, RCP

2. Where we were VAP Rate/ 1000 ventilator days

4. Where we are now Last VAP January 2011

5. How did we get there?

6. Step 1: Examine the evidence

7. Step 2: Find a Champion

8. Step 3: Engage a team

9. Step 4: Small tests of change

10. Step 5: Rapid Cycle Improvement

11. Step 6: Build on Success

12. ABCDE Building Blocks Wake up and breath protocols Ventilator bundles CAM-ICU Daily ventilator rounds ICU OT/PT staffing

13. What Were Our Barriers? Inertia Staffing Skeptical doctors Antiquated chart system Data gathering

14. How Did We Overcome These Barriers? EBM Use people’s normal work flow Invite participation from all team members Showcase results Engage quality and infection control managers

15. What Did We Learn From This Improvement Effort? Don’t try everything at once Culture beats strategy Engaged leaders Put front line workers in charge Data collection is not easy

19. What Can We Teach From Our Journey? Step 1: Find the evidence of efficacy Step 2: Find a champion Step 3: Engage the team Step 4: Small tests of change Step 5: Rapid cycle improvement—don’t expect perfection Step 6: Share and build on your successes Step 7: Lather, rinse repeat

20. Feel Free to Contact Us: Stuart Forman, MD, FAAFP Medical Director, Critical Care Services 2500 Alhambra Ave. Martinez, CA 94553 Stuart.forman@hsd.cccounty.us