Ventilator-Associated Pneumonia in the Trauma Patient:

An Accident Prevented by Thinking Outside the Bundle Susan Ashcraft MSN, RN, ACNS-BC, Heather Klenk BSN, RN, Denise Wolfe RN, CNRN, Heather Pitts RD, LDN,

Megan Powell BSN RN, Jessica Jarvis BSN, RN, Devon Lofters BSN, RN

Background and Objectives

Conclusion

Method

References

Results

A review of the literature revealed the positive impact of

team rounding and use of an interdisciplinary tool on VAP

rates (Byrnes et al 2009; Chua et al 2010; DuBose et al

2010; Laux et al 2010; Heimes et al 2011). Each

discipline was responsible for confirming specific

evidenced-based practices that prevent VAP. These

strategies were then embedded into a check-off tool to be

used during rounding. Initially, interdisciplinary team

rounding occurred twice a week. Modifications to the tool

occurred frequently to improve communication during

rounding. Recognizing the impact that rounding made on

ensuring timely interventions, the Neuro ICU began using

the tool to round every day on all ventilated patients while

maintaining biweekly interdisciplinary rounding with the

Trauma Services. Byrnes, MC et al. Implementation of a mandatory checklist of protocols and objectives improves

compliance with a wide range of evidence-based intensive care unit practices. Critical Care Medicine 2009.

37(10): 2775-278.

Chua, C et al. Multidisciplinary trauma intensive care unit checklist: Impact on infection rates. Journal of

Trauma Nursing 2010. 17(3): 163-166.

DuBose, J et al. Measurable outcomes of quality improvement using a daily quality rounds checklist: One-

year analysis in a trauma intensive care unit with sustained ventilator-associated pneumonia reduction. The

Journal of Trauma Injury, Infection and Critical Care 2010. 69(4):855-860.

Heimes, J et al. Implementation and enforcement of ventilator-associated pneumonia prevention strategies

in trauma patients. Surgical Infections 2011. 12(2):99-103.

Laux, L et al. Trauma VAP swat team: A rapid response to infection prevention. Critical Care Nursing

Quarterly 2010. 33(2): 126-131.

Ventilator-associated pneumonia (VAP) is a significant

problem in trauma patients increasing mortality and cost of

care. While monitoring adherence to VAP prevention

strategies reflected 98% compliance, our VAP rate

revealed monthly variation (0-34) and a plateau for two

consecutive years (8.04). Nurses in the Neuro ICU

recognized the need to apply different strategies to impact

trauma patients’ outcomes. A team was created for the

purpose to decrease VAP in the trauma patients.

0

1

2

3

4

5

6

7

6.68

3.61

2.84

2.38

2010 2011 2012 2013

VAP Rate

The above tool was used daily during interdisciplinary rounds,

which included nursing, dietitian, pharmacist, respiratory therapy,

physical therapy and nursing leadership. Our Trauma Team also

attended rounds biweekly to participate in the rounding process. Since implementation of intentional VAP rounding and daily

use of the interdisciplinary tool, Trauma Services have

experienced a zero VAP rate for six consecutive months.

Implementing the same process on every ventilated patient,

the Neuro ICU has decreased their overall VAP rate from 3.0

to 1.54 over the same period. Vigilance to ensure continued

rounding and prompt implementation of interventions

continues to be a strategy supported by leadership.

N=9 N=5 N=3 N=1