1. CUSP 4 MVP – VAP Improving Care for Mechanically Ventilated Patients Data Feedback: SubG ETT, Head of Bed Elevation and Delirium Assessment Utilization ARMSTRONG INSTITUTE FOR PATIENT SAFETY AND QUALITY Johns Hopkins University

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

3. 3 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar Webinar Objectives 1.Review data submission rates and results for SubG ETT, HOB, and delirium assessment use. 2.Discuss how collecting this data has fueled improved care for mechanically ventilated patients in ICUs. 3.Review the process for accessing and downloading data reports.

4. 4 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar Daily Care Processes – Cohort 1 Data Collection Schedule

5. 5 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar Daily Care Processes – Sub-G ETT, HoB, Delirium

6. 6 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar Daily Care Processes – Data Completion Rates Number of Cohort 1 Units*N% Total active hospital units 41100% Number of hospital units that have submitted data 2868% Number of hospital units that have never submitted data 1332% * As of March 10, 2015

7. 7 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar Subglottic Endotracheal Tubes Usage of subglottic endotracheal tubes are recommended. Visit https://armstrongresearch.hopkinsmedicine.org/cusp4mvp/processmeasures.aspx for fact sheets and literature reviews.https://armstrongresearch.hopkinsmedicine.org/cusp4mvp/processmeasures.aspx

8. 8 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar Subglottic Suctioning Study 1 Randomized controlled clinical trial conducted in five ICUs of the same hospital Confirm effect of subglottic secretion suctioning on VAP prevalence to assess concomitant impact on VAC and antibiotic use N=352 adult patients intubated with tracheal tube allowing subglottic secretion suctioning –N=170, group 1 underwent suctioning –N=182, group 2 did not undergo suctioning Damas P, Frippiat F, Ancion A, Canivet JL, Lambermont B, Layios N, Massion P, Morimont P, Nys M, Piret S, Lancellotti P, Wiesen P, D'orio V, Samalea N, Ledoux D. Prevention of ventilator-associated pneumonia and ventilator-associated conditions: a randomized controlled trial with subglottic secretion suctioning. Crit Care Med. 2015 Jan;43(1):22-30. PMID: 25343570.

9. 9 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar Results of Subglottic Suctioning Study Suction Group 1 (n=170) No Suction Group 2 (n=182) VAP8.8%, 15 patients17.6%, 32 patients VAP by vent days9.6 of 1000 days19.8 of 1000 days VAC21.8%22.5% Antibiotic days61% 1696 of 2754 days 68.5% 1965 of 2868 days

10. 10 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar Impact of Subglottic Secretion Suctioning Significant reduction of VAP prevalence Significant decrease in antibiotic use Among 47 patients with VAP, 25 (58.2%) experienced a VAC –VAC did not differ between groups –Related to other medical features, rather than VAP Neither ICU LOS nor mortality differed Only VAC associated with increased mortality

11. 11 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar Subglottic Endotracheal Tube Calculations Numerator – Total number of patients with first Sub-G ETT value being “Yes” Denominator – Total number of patients with first Sub-G ETT value being either “Yes” or “No”

12. 12 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar Subglottic Endotracheal Tube Utilization Rates

13. 13 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar Subglottic Endotracheal Tube Utilization Rates Q2 2014 Q3 2014 Q4 2014 Q1 2015 SubG ETT Utilization Rates26.5%27.0%30.3%19.1% Number of patient days in which SubG ETT were used (numerator) 24116111456 Number of SubG ETT-eligible patient days (denominator) 909596376293

14. 14 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar Head of Bed Elevation  30  The elevation of the head of bed to a semi-recumbent position (≥30 degrees) is associated with a decreased incidence of aspiration and Ventilator- Associated Pneumonia (VAP). Visit https://armstrongresearch.hopkinsmedicine.org/cusp4mvp/processmeasures.aspx for fact sheets and literature reviewshttps://armstrongresearch.hopkinsmedicine.org/cusp4mvp/processmeasures.aspx

15. 15 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar Head of Bed Elevation  30  Compliance Calculations Numerator – Total number of patient- days with HoB  30  being “Yes” Denominator – Total number of patient-days with HoB  30  being either “Yes” or “No”

16. 16 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar Head of Bed Elevation  30  Compliance Rates

17. 17 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar Head of Bed Elevation  30  Compliance Rates Q2 2014 Q3 2014 Q4 2014 Q1 2015 HoB Elevation Rates97.8%98.4%97.7%99.4% Number of patient days in which HoB elevation was used (numerator) 5346363721971772 Number of HoB-eligible patient days (denominator) 5464369822491783

18. 18 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsMarch 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 https://armstrongresearch.hopkinsmedicine.org/cusp4mvp/processmeasures.aspx for fact sheets and literature reviews.https://armstrongresearch.hopkinsmedicine.org/cusp4mvp/processmeasures.aspx

19. 19 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar Delirium Assessment Utilization Calculations Numerator – Total number of patient days with Intub/Trach & Mech Vent marked “Yes” and 1.CAM-ICU is marked “Positive” or “Negative or; 2.A numeric ASE value is recorded

20. 20 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar Delirium Assessment Utilization Calculations Denominator – Total number of patient days with Intub/Trach & Mech Vent marked “Yes” and 1.CAM-ICU is marked “Positive” or “Negative” or “X – Not completed” or “NK-Not Known or; 2.A numeric ASE value or ASE is marked “X” or “NL”

21. 21 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar Delirium Assessment Utilization Rates

22. 22 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar Delirium Assessment Utilization Rates Q2 2014 Q3 2014 Q4 2014 Q1 2015 Delirium Utilization Rates67.9%78.8%94.8%94.5% Number of patient days in which delirium assessments were issued (numerator) 174717101092828 Number of delirium assessment-eligible patient days (denominator) 257421701152876

23. 23 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar Summary  SubG ETT ~ 25% utilization rate overall  HoB >95% utilization rate overall  Delirium Assessment Between 60-95% utilization rate overall

24. 24 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar Next Steps Continue using the Daily Care Process Data Collection Tool to track progress. Continue entering data into the data portal receive data reports and monitor improvement. Work with hospital leaders to institute subglottic endotracheal tubes usage in your ICU.

25. 25 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar Helpful Links Fact sheets and literature reviews https://armstrongresearch.hopkinsmedicine.org/cusp4mvp/processmeasur es.aspx Data Measures Definitions and Formulas (Scroll to bottom of page and click on “Data Measures Definitions”) https://armstrongresearch.hopkinsmedicine.org/cusp4mvp/datatools.aspx CUSP 4 MVP-VAP Data Portal https://armstrongresearch.hopkinsmedicine.org/MyTools.aspx

26. How to Access Data Reports

27. 27 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar Go to the CUSP 4 MVP – VAP Homepage: https://armstrongres earch.hopkinsmedic ine.org/cusp4mvp.a spx. https://armstrongres earch.hopkinsmedic ine.org/cusp4mvp.a spx Click on “Data Entry and Reports.”

28. 28 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar Log in.

29. 29 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar Click on “My Network Performance.”

30. 30 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar Choose the time period that you want. Choose the app that you want.

31. 31 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar Click “View Chart” under the measure that you would like to view. In this example, we are looking at Delirium Assessment Compliance Rates.

32. 32 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar A graph will appear on the bottom. Click the PDF icon to download the report.

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

34. 34 CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated PatientsMarch 2015 Cohort 1 Data Webinar