CUSP 4 MVP – VAP Improving Care for Mechanically Ventilated Patients Early Mobility: Data Feedback and Team Presentations ARMSTRONG INSTITUTE FOR PATIENT SAFETY AND QUALITY Johns Hopkins University

2 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsApril 2015 Cohort 1 Data Webinar

3 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsApril 2015 Cohort 1 Data Webinar Webinar Objectives 1.Review data results for April 2014 through March 2015 (four quarters). 2.Discuss how implementing early mobility protocols and collecting this data has improved care for mechanically ventilated patients in your units. 3.Review the process for accessing and downloading data reports.

4 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsApril 2015 Cohort 1 Data Webinar Early Mobility: What Have We Learned to Date? Past Content Calls –Apr 1, 2014: Daily Early Mobility Overview –Jul 1, 2014: Early Mobility: A Practical Approach –Nov 4, 2014: Early Mobility and Delirium

5 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsApril 2015 Cohort 1 Data Webinar Early Mobility: What Have We Learned to Date? Prolonged bed rest and immobility can lead to: –impaired physical function; –Cognitive impairment; –Psychiatric illness. Immobility can also lead to cognitive impairment (e.g. impaired executive function, inattention).

6 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsApril 2015 Cohort 1 Data Webinar

7 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsApril 2015 Cohort 1 Data Webinar Daily Early Mobility: Sedation, Delirium, Mobility

8 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsApril 2015 Cohort 1 Data Webinar Daily Early Mobility: Evidence-based Guidelines Use the Daily Early Mobility Data Collection Tool to monitor compliance with evidence- based guidelines such as: 1.performing structured assessments of sedation levels using a sedation scale (RASS or SAS); 2.performing structured assessments of delirium using a delirium scale (CAM-ICU or ASE); 3.assisting patients to achieve their highest level of mobility.

9 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsApril 2015 Cohort 1 Data Webinar Daily Early Mobility: Sedation, Delirium, Mobility 123

10 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsApril 2015 Cohort 1 Data Webinar Daily Early Mobility: Data Submission Rates Number of Cohort 1 Units*N Total active hospital units 41 Number of hospital units that have submitted data 23 (56.1%) * As of April 7, 2015

11 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsApril 2015 Cohort 1 Data Webinar Early Mobility: Sedation Recommended sedation scales include: –Richmond Agitation Sedation Scale (RASS) –Riker Sedation-Agitation Scale (SAS) Track the target and actual RASS/SAS scores for the patient

12 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsApril 2015 Cohort 1 Data Webinar Daily Early Mobility: Sedation Percentage of patients achieving patients achieving RASS/SAS target

13 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsApril 2015 Cohort 1 Data Webinar NUMERATOR = Total number of patient days with Intub/Trach & Mech Vent marked “Y” (Yes) and: 1)RASS actual score = RASS target score or RASS actual score is less than or equal to +1 and is greater than the RASS target score OR 2)SAS actual score = SAS target score or SAS actual score is less than or equal to 5 and is greater than the SAS target score DENOMINATOR = Total number of patient days with Intub/Trach & Mech Vent marked “Y” and 1)A numeric RASS target score and a numeric RASS actual score OR 2)A numeric SAS target score and a numeric SAS actual score % Achieving RASS/SAS target Calculation

14 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsApril 2015 Cohort 1 Data Webinar Delirium Assessments Adult ICU patients should be assessed for delirium using at least once per shift. The Confusion Assessment method for the ICU (CAM-ICU) is a recommended tool to for assessing delirium. Visit for fact sheets and literature reviews.

15 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsApril 2015 Cohort 1 Data Webinar Early Mobility: Delirium Delirium assessment participation rates

16 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsApril 2015 Cohort 1 Data Webinar Delirium Assessment Participation Rates: Calculations NUMERATOR = Total number of patient days with Intub/Trach & Mech Vent marked “Y” (Yes) and: 1)CAM-ICU is marked “P” (Positive) or “N” (Negative) OR 2)A numeric ASE value is recorded DENOMINATOR = Total number of patient days with Intub/Trach & Mech Vent marked “Y” and: 1)CAM-ICU is marked “P” or “N” or “X” (Not Completed) or “NK” (Not Known) OR 2)A numeric ASE value or ASE is marked “X” or “NK”

17 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsApril 2015 Cohort 1 Data Webinar Daily Early Mobility: Delirium Percentage of patients screening negative for delirium (as indicated through CAM-ICU or ASE)

18 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsApril 2015 Cohort 1 Data Webinar Negative Delirium Screenings (as indicated through CAM-ICU or ASE) : Calculations NUMERATOR = Total number of patient days with Intub/Trach & Mech Vent marked “Y” (Yes) and: 1)CAM-ICU is marked “N” (Negative) OR 2)ASE is less than or equal to 2 DENOMINATOR = Total number of patient days with Intub/Trach & Mech Vent marked “Y” and: 1)CAM-ICU is marked “P” or “N” OR 2)A numeric ASE value is recorded

19 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsApril 2015 Cohort 1 Data Webinar Daily Early Mobility: Delirium Percentage of patient days mobilized out of bed

20 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsApril 2015 Cohort 1 Data Webinar Percentage of patient days mobilized out of bed: Calculations NUMERATOR = Total number of patient days with Intub/Trach & Mech Vent marked “Y” and with highest level of mobility marked (4-standing, 5-transfer from bed to chair with standing, 6-marching in place, 7-walking) DENOMINATOR = Total number of patient days with Intub/Trach & Mech Vent marked “Y” 4, 5, 6, 7

21 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsApril 2015 Cohort 1 Data Webinar Summary Percentage of patients receiving target RASS/SAS scores is improving Percentage of patients receiving delirium assessments is improving Delrium rates appear to be on the decline Not much improvement mobilizing patients out of bed sooner Good Needs improvement

22 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsApril 2015 Cohort 1 Data Webinar Let’s hear from some of our Cohort 1 teams! Emily Pasola, MSN, RN, CNL Kassie Basnight, RN, BSN

23 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsApril 2015 Cohort 1 Data Webinar Next Steps Continue using a protocol to achieve the highest level of mobility possible for patients. Continue using the Daily Early Mobility Data Collection Tool to track progress. Continue entering data into the data portal receive data reports and monitor improvement. Attend the May 5, 2015 Cohort 1 Content Webinar (Topic: The 4 Es of Early Mobility & Presentations from Teams on Early Mobility Implementation).

24 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsApril 2015 Cohort 1 Data Webinar Helpful Links Early Mobility Toolkit px Data Measures Definitions and Formulas (Scroll to bottom of page and click on “Data Measures Definitions”) CUSP 4 MVP-VAP Data Portal Early mobility assessment and treatment steps from SCCM ICU Liberation project

How to Access Data Reports

26 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsApril 2015 Cohort 1 Data Webinar Go to the CUSP 4 MVP – VAP Homepage: earch.hopkinsmedic ine.org/cusp4mvp.a spx. earch.hopkinsmedic ine.org/cusp4mvp.a spx Click on “Data Entry and Reports.”

27 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsApril 2015 Cohort 1 Data Webinar Log in.

28 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsApril 2015 Cohort 1 Data Webinar Click on “My Network Performance.”

29 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsApril 2015 Cohort 1 Data Webinar Choose the time period that your heart desires. Choose the app that you would like to view!

30 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsApril 2015 Cohort 1 Data Webinar There are several Early Mobility reports that are available for you to view. They include: Adverse event rates Delirium assessment participation rates RASS/SAS Target percentages CAM-ICU/ASE percentages % patient days mobilized out of bed Click “View Chart” under the measure that you would like to view. In this example, we are looking at Delirium Assessment Compliance Rates.

31 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsApril 2015 Cohort 1 Data Webinar A graph will appear on the bottom. Click the PDF icon to download the report.

32 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsApril 2015 Cohort 1 Data Webinar

33 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsApril 2015 Cohort 1 Data Webinar