beyond the double doors edit.pdf
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7/28/2019 Beyond the Double Doors Edit.pdf
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B y K i m b e r l y H a i n e s , R N
It’s ironic when you think about it – a mechanism
designed to keep patients alive can actually make them
sicker and even kill them.
We’re talking about ventilators, or, more specically,
ventilator-associated pneumonia (VAP). Most surgical
patients undergo general anesthetic for their procedures
and are then extubated in the operating room at the end
of surgery. Critically ill patients, however, remain intubated
after being transported from the operating room to the ICU.
Stop and think for a second about how long those patients
might remain on ventilators. As hours and days tick by,
the risk of VAP grows exponentially.
VAP typically occurs after 48 hours of intubation and is
a leading cause of death among patients who contract
nosocomial infections. In addition to prolonging a patient’s
hospital stay, VAP also adds an estimated cost of $40,000
per admission. Ultimately, approximately 46 percent of
patients who develop VAP will not survive. 1
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In an eort to reduce post-operative complications, the Surgical Care
Improvement Project (SCIP) has targeted post-operative VAP as one of four
areas requiring improvement. According to SCIP, sta education regarding
best practices and new technologies as well as eective communication leads
to quality improvement. The organization also states that standardized
processes lead to improved consistent care and better outcomes.2
The prevention of ventilator-associated pneumonia is also a goal of the
Institute of Healthcare Improvement (IHI) 100,000 Lives Campaign.
The organization has put together a how-to guide to prevent VAP. The
guide advocates the use of a ventilator bundle, which is a grouping of best
practices that result in signicant improvement in the prevention of VAP.
Some facilities have seen a 45 percent decrease in VAP using this bundled
approach. The IHI bundle was designed to increase adherence to basic
preventative measures, and includes the following therapies:1
Elevating the head of the bed
• Elevating the head of the hospital bed 30 degrees to 45 degrees
improves ventilation and reduces the likelihood of atelectasis and
aspiration of gastric contents.Deep vein thrombosis (DVT) prophylaxis
• The rate of DVT increases in sedentary sedated patients.
Peptic ulcer prophylaxis
• The mortality rate of patient’s increases ve times in documented
occurrences of gastrointestinal bleeding related to stress ulcerations.
Aspiration of gastric contents might precipitate pneumonia.
Sedation vacation
• Daily interruption of sedation allows assessment of the patient’s
readiness to be extubated. A reduced sedative state also allows
the patient to assist in extubation by controlling secretions and
coughing. Patient ventilation time decreased almost 50 percent
using this technique.
While the IHI acknowledges additional therapies such as subglottic suctioning
and oral care can also decrease the risk of VAP, these therapies were not
included in the IHI bundle. The bundle includes only therapies the IHI felt
could be implemented rapidly and were readily available at all facilities.1
The prevention of ventilator-associated pneumonia requires a multidisciplinary
approach. The next time an intubated patient is transported to the ICU,
theses therapies should be considered. They might save the patient’s life.
References:1 Institute for Healthcare Improvement. Getting Started Kit: Prevent Ventilator Associated
Pneumonia. How-to Guide. Available at: http://www.ihi.org. Accessed May 24, 2007.2 Surgical Care Improvement Project. Respiratory. Available at: http://medqic.org/scip.
Accessed May 24, 2007.
About the author
Kimberly Haines, currently a clinical nurse consultant, has been
an RN for 13 years. Previously, she was a sta nurse at a number
of acute care facilities and ambulatory surgery centers.
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