OGDENSBURG – Claxton-Hepburn Medical Center was cited in Washington D.C. recently as an example of a small hospital capable of making major headway in reducing medical errors by using …
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OGDENSBURG – Claxton-Hepburn Medical Center was cited in Washington D.C. recently as an example of a small hospital capable of making major headway in reducing medical errors by using evidence-based procedures.
Dr. Donald Berwick, administrator for the Centers for Medicare & Medicaid Services, highlighted the local hospital while speaking Wednesday to a U. S. Senate panel examining the implementation of the new health care law in Washington DC.
Claxton-Hepburn hasn’t had a case of Ventilator-Associated Pneumonia (VAP) in more than four years since implementing evidence-based strategies instead of leaving management of ventilators up to individual physicians.
Previously, one in three patients on ventilators got pneumonia, according to the Institute of Healthcare Improvement. Of those, half died, and the rest were costly to treat, IHI said.
“IHI demystified a lot of what is going on as far as evidence-based standards go,” said Jennifer S Shaver, RN, NM/ICU and OB as quoted on the IHI website. “Just the fact that we could communicate with hospitals in other states and ask them what they’ve been doing was a tremendous benefit.”
Over the last four years, Claxton-Hepburn has mentored other hospitals on how to prevent ventilator-associated pneumonia and provide a higher quality of care overall.
Details of the Claxton-Hepburn program, as reported by www.ihi.org/IHI/Programs/Campaign/mentor_registry_vap.htm, follow:
“In our ICU, ventilator management was traditionally contingent upon individual physician preference, and did not consistently employ (current) evidence-based strategies. In 2004, we began addressing the occurrence of VAP in our 10-bed Medical Surgical ICU. The only physician champions that "bought in" to the process were heavily vested in other initiatives.
“The team:
• Provided both formal and informal education to all involved disciplines on VAP, as well as evidence-based strategies proven to reduce VAP occurrence.
• Shared feedback to providers regarding successes.
• Supported nursing and respiratory staff in (discipline-specific) clinical decision making.
• Facilitated the redesign of our nursing and respiratory therapy documentation to easily capture the expectation of care.
• Praised the nurse, respiratory and physician leaders who "bought in" early, and coached the skeptics.
• Provided current evidence-based literature for those critical conversations that involved coaching opportunities
• Implemented a physician-order set after we had developed an ICU- and respiratory therapist-driven culture that was highly motivated to reduce VAP.
• Posted graphs inside the ICU to detail compliance with the vent bundle performance measures.
• Implemented a physician order set for all ICU ventilated patients that was ultimately embraced by our medical staff.
• Initiated a framework for successful employment of subsequent initiatives.
• Offered assistance to peers from other institutions in regards to developing and applying similar protocols.
Results by year follow:
Results by year follow:
2005 2006 2007 2008 2009
Head of bed up 98% 85% 100% 100% 100%
Weaning Assessment 41% 73% 100% 96% 100%
PUD prophylaxis 100% 96% 100% 96% 100%
DVT prophylaxis 98% 92% 100% 100% 100%
Oral Hygiene n/a n/a n/a 100% 100%
Mean am FGlu 139mg/dL 130 mg/dL 131 mg/dL 132 mg/dL 150mg/dL
Occurrence of VAP 0 0 0 0 0
“A collateral benefit, not anticipated at the initiation of our project, was the actual reduction in ventilator hours per patient. Traditionally tracked as “vent days,” our rural setting allows a more hands-on approach to documentation, and subsequent data collection.
“Ventilator hours per patient (time frame from ventilator application to liberation) has significantly decreased over 5 years.”