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Ventilator-Associated Events A Patient Safety Opportunity Michael Klompas MD, MPH, FRCPC, FIDSA, FSHEA Harvard Medical School, Harvard Pilgrim Health Care Institute, and Brigham and Women’s Hospital, Boston, USA CUSP for Mechanically Ventilated Patients November 19, 2014
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Page 1: Ventilator-Associated Events A Patient Safety Opportunity Michael Klompas MD, MPH, FRCPC, FIDSA, FSHEA Harvard Medical School, Harvard Pilgrim Health Care.

Ventilator-Associated EventsA Patient Safety Opportunity

Michael Klompas MD, MPH, FRCPC, FIDSA, FSHEA

Harvard Medical School,

Harvard Pilgrim Health Care Institute, and

Brigham and Women’s Hospital, Boston, USA

CUSP for Mechanically Ventilated Patients

November 19, 2014

Page 2: Ventilator-Associated Events A Patient Safety Opportunity Michael Klompas MD, MPH, FRCPC, FIDSA, FSHEA Harvard Medical School, Harvard Pilgrim Health Care.

Disclosures

Grant funding from the US Centers for Disease Control and Prevention

Honoraria from Premier Healthcare Alliance for lectures on VAP surveillance

Page 3: Ventilator-Associated Events A Patient Safety Opportunity Michael Klompas MD, MPH, FRCPC, FIDSA, FSHEA Harvard Medical School, Harvard Pilgrim Health Care.

Ventilator-associated pneumonia

Affects ~5-10% of ventilated patients

Increases ICU length of stay by ~4-7 days

Increases hospital length of stay by ~14 days

Crude mortality rate 30-50%

Attributable mortality 8-12%

Adds ~$10-50,000 to cost of hospital stay

CMS 1533-P, 2007Safdar et al, Crit Care Med 2005; 33:2184

Tejerina et al, J Crit Care 2006; 21:56 Muscedere et al, J Crit Care 2008;23:5-10

Eber et al, Arch Intern Med 2010;170:347-353Nguile-Makao et al, Intensive Care Med 2010;36:781-9

Beyersmann et al, Infect Control Hosp Epidemiol 2006;27:493

Page 4: Ventilator-Associated Events A Patient Safety Opportunity Michael Klompas MD, MPH, FRCPC, FIDSA, FSHEA Harvard Medical School, Harvard Pilgrim Health Care.

VAP

Page 5: Ventilator-Associated Events A Patient Safety Opportunity Michael Klompas MD, MPH, FRCPC, FIDSA, FSHEA Harvard Medical School, Harvard Pilgrim Health Care.

States with mandatory reporting legislation for healthcare-associated infections

Association for Professionals in Infection Control and Epidemiology 2012

Mandatory reporting enacted

Study bill

Page 6: Ventilator-Associated Events A Patient Safety Opportunity Michael Klompas MD, MPH, FRCPC, FIDSA, FSHEA Harvard Medical School, Harvard Pilgrim Health Care.

2016 National Patient Safety Goal(proposed)

Prevent ventilator-associated pneumonia

Page 7: Ventilator-Associated Events A Patient Safety Opportunity Michael Klompas MD, MPH, FRCPC, FIDSA, FSHEA Harvard Medical School, Harvard Pilgrim Health Care.

“Centers for Medicare and Medicaid Services (CMS)announced its decision to cease paying hospitals for some of the

care made necessary by ‘preventable complications’”

Page 8: Ventilator-Associated Events A Patient Safety Opportunity Michael Klompas MD, MPH, FRCPC, FIDSA, FSHEA Harvard Medical School, Harvard Pilgrim Health Care.

These initiatives all presume we can accurately identify and track who does and does not have VAP….

…but VAP is a difficult diagnosis.

Page 9: Ventilator-Associated Events A Patient Safety Opportunity Michael Klompas MD, MPH, FRCPC, FIDSA, FSHEA Harvard Medical School, Harvard Pilgrim Health Care.

Diagnostic Criteria for VAP

High Temp

Low Temp

High WBC

Low WBC

Low P:F Ratio

Increased vent settings

Purulent secretions

Gram stain neutrophils

New AntibioticStart

Infiltrate

CDC Old Definition ✓ ✓ ✓ ✓ ✓ ✓ ✓CDC New Definition ✓ ✓ ✓ ✓ ✓ ✓ ✓HELICS Criteria ✓ ✓ ✓ ✓ ✓ACCP Criteria ✓ ✓ ✓ ✓ ✓Clinical Pulmonary Infection Score ✓ ✓ ✓ ✓ ✓ ✓ ✓Johanson’s Criteria ✓ ✓ ✓ ✓

Ego et al. Chest 2014;ePub ahead of print

Page 10: Ventilator-Associated Events A Patient Safety Opportunity Michael Klompas MD, MPH, FRCPC, FIDSA, FSHEA Harvard Medical School, Harvard Pilgrim Health Care.

Impact of Diagnostic Criteria on VAP Prevalence

CDC Old

Criter

ia

CDC New

Crit

eria

HELICS

ACCPCPIS

Joha

nson

0

10

20

30

40

Nu

mb

er o

f V

AP

sProspective surveillance, 1824 patients, Tertiary Med-Surg Unit, Belgium

Ego et al. Chest 2014;ePub ahead of print

Page 11: Ventilator-Associated Events A Patient Safety Opportunity Michael Klompas MD, MPH, FRCPC, FIDSA, FSHEA Harvard Medical School, Harvard Pilgrim Health Care.

CDC’s old surveillance definition for VAP

Patient must fulfill each of the three categories below:ChestRadiograph

Any one of the following:1. New, progressive, or persistent infiltrate2. Consolidation3. Cavitation

Systemic Signs

Any one of the following:1. Temperature >38°C2. WBC <4,000 or >12,000 WBC/mm3

3. For adults 70 years old, altered mental status with no other recognized cause

Pulmonary Signs

Any two of the following:1. New onset of purulent sputum, or change in character

of sputum, or increased respiratory secretions, or increased suctioning requirements

2. New onset or worsening cough, or dyspnea, or tachypnea

3. Rales or bronchial breath sounds4. Worsening gas exchange, increased oxygen

requirements, or increased ventilation demand

Page 12: Ventilator-Associated Events A Patient Safety Opportunity Michael Klompas MD, MPH, FRCPC, FIDSA, FSHEA Harvard Medical School, Harvard Pilgrim Health Care.

Complicated

Labor Intensive

Subjective

Non-Specific

Page 13: Ventilator-Associated Events A Patient Safety Opportunity Michael Klompas MD, MPH, FRCPC, FIDSA, FSHEA Harvard Medical School, Harvard Pilgrim Health Care.
Page 14: Ventilator-Associated Events A Patient Safety Opportunity Michael Klompas MD, MPH, FRCPC, FIDSA, FSHEA Harvard Medical School, Harvard Pilgrim Health Care.

“Diffuse patchy airspace disease right greater than left with obliteration of both hemi-diaphragms. Opacities possibly slightly increased since yesterday accounting for changes in patient position and inspiration. This could represent atelectasis, pneumonia, or effusion.”

Page 15: Ventilator-Associated Events A Patient Safety Opportunity Michael Klompas MD, MPH, FRCPC, FIDSA, FSHEA Harvard Medical School, Harvard Pilgrim Health Care.

Sources of fever and infiltrates

ARDS

Diffuse alveolar damage

Thromboembolic disease

Hemorrhage

Infarction

Fibrosis

Carcinoma

Lymphoma

Contusion

Tracheobronchitis

CLABSI

UTI

Drug fever

Meduri, Chest 1994; 106:221-235Petersen, Scand J Infect Dis 1999; 31:299-303

Pulmonary edema

Atelectasis

Contusion

Fibrosis

PLUS

Page 16: Ventilator-Associated Events A Patient Safety Opportunity Michael Klompas MD, MPH, FRCPC, FIDSA, FSHEA Harvard Medical School, Harvard Pilgrim Health Care.

Accuracy of clinical diagnosis of VAPRelative to 253 autopsies

80%

100%

Sen

sit

ivit

y /

P

osit

ive P

red

icti

ve V

alu

e

60%

40%

20%

0%PositivePredictiv

eValue

Tejerina et al., J Critical Care 2010;25:62

Sensitivity

Loose definition:Infiltrate and 2 of temp / wbc / purulence

Strict definition:Infiltrate and 3 of temp / wbc / purulence

Page 17: Ventilator-Associated Events A Patient Safety Opportunity Michael Klompas MD, MPH, FRCPC, FIDSA, FSHEA Harvard Medical School, Harvard Pilgrim Health Care.

Accuracy of quantitative BAL culturesRelative to histology

80%

100%

Sen

sit

ivit

y /

P

osit

ive P

red

icti

ve V

alu

e

60%

40%

20%

0%PositivePredictiv

eValue

Kirtland, Chest 1997;112:445Fabregas, Thorax 1999;54:867

Chastre, Am Rev Respir Dis 1984;130:924Torres, Am J Resp Crit Care Med 1994;149:324

Marquette, Am J Resp Crit Care Med 1995;151:1878Papazian, Am J Resp Crit Care Med 1995;152:1982

Sensitivity

Page 18: Ventilator-Associated Events A Patient Safety Opportunity Michael Klompas MD, MPH, FRCPC, FIDSA, FSHEA Harvard Medical School, Harvard Pilgrim Health Care.

Implications for surveillance

Page 19: Ventilator-Associated Events A Patient Safety Opportunity Michael Klompas MD, MPH, FRCPC, FIDSA, FSHEA Harvard Medical School, Harvard Pilgrim Health Care.

Interobserver agreement in VAP surveillance

7

IP 1 (11 VAPs)

IP 2(20 VAPs)3

30

1 7

5

IP 3 (15 VAPs)

Klompas, AJIC 2010:38:237Kappa = 0.40

50 ventilated patients with respiratory deterioration

Page 20: Ventilator-Associated Events A Patient Safety Opportunity Michael Klompas MD, MPH, FRCPC, FIDSA, FSHEA Harvard Medical School, Harvard Pilgrim Health Care.

6 Case Vignettes Presented to 43 Surveyors

0

1

2

3

4

5

6

Survey Respondents

Nu

mb

er o

f V

AP

s

Crit Care Med 2014;42:497

Page 21: Ventilator-Associated Events A Patient Safety Opportunity Michael Klompas MD, MPH, FRCPC, FIDSA, FSHEA Harvard Medical School, Harvard Pilgrim Health Care.

Ways to lower VAP ratesWithout meaningfully changing patient care

1. Narrowly interpret subjective clinical signs

2. Narrowly interpret radiographs

3. Seek consensus between multiple surveyors

4. Allow clinicians to veto surveillance determinations

5. Increase use of quantitative BAL for diagnosis

Klompas, Clin Infect Dis 2010:51:1123-26Klompas, Am J Infect Control 2012;40:408-10

Page 22: Ventilator-Associated Events A Patient Safety Opportunity Michael Klompas MD, MPH, FRCPC, FIDSA, FSHEA Harvard Medical School, Harvard Pilgrim Health Care.

U.S. National VAP ratesUnited States, 2004-2012

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20130

2

4

6

8

10

VA

Ps

per

100

0 ve

nt-

day

s

Source: CDC NNIS and NHSN

SICUs

MICUs

Page 23: Ventilator-Associated Events A Patient Safety Opportunity Michael Klompas MD, MPH, FRCPC, FIDSA, FSHEA Harvard Medical School, Harvard Pilgrim Health Care.

International VAP Rates

Italy

Austria

Scotla

nd

France

Spain

Belgiu

m

USA Surg

ical

USA Med

ical

0

4

8

12

16

20

Mea

n V

AP

Rat

e

Source: CDC Europe and CDC USA

Page 24: Ventilator-Associated Events A Patient Safety Opportunity Michael Klompas MD, MPH, FRCPC, FIDSA, FSHEA Harvard Medical School, Harvard Pilgrim Health Care.

Increasing gap between clinical and surveillance VAP rates

Thomas et al. Am Surgeon 2011;77:998Skrupky et al. Crit Care Med 2012;40:281

Koulenti et al. Crit Care Med 2009;37:2360Vincent et al. JAMA 2009;302:2323

0

20

40

60

80

100Clinical Diagnosis Surveilance Diagnosis

15% of ICU pts on

VAP Rx on cross-sectional surveys

No.

of

Pat

ient

s

Page 25: Ventilator-Associated Events A Patient Safety Opportunity Michael Klompas MD, MPH, FRCPC, FIDSA, FSHEA Harvard Medical School, Harvard Pilgrim Health Care.

We need to publicly report VAP rates to catalyze

improved quality of care and save lives!

But the definition of VAP is ambiguous, hard to

implement, and open to be gamed!

Where does this leave hospitals?

Page 26: Ventilator-Associated Events A Patient Safety Opportunity Michael Klompas MD, MPH, FRCPC, FIDSA, FSHEA Harvard Medical School, Harvard Pilgrim Health Care.
Page 27: Ventilator-Associated Events A Patient Safety Opportunity Michael Klompas MD, MPH, FRCPC, FIDSA, FSHEA Harvard Medical School, Harvard Pilgrim Health Care.

Critical Care Medicine 2013;41:2467-2475

Page 28: Ventilator-Associated Events A Patient Safety Opportunity Michael Klompas MD, MPH, FRCPC, FIDSA, FSHEA Harvard Medical School, Harvard Pilgrim Health Care.

An alternative approach to surveillance

Broaden the focus from pneumonia alone to the syndrome of ventilator complications in general

• More accurate description of what can be reliably determined using surveillance definitions

• Emphasizes the importance of preventing all complications of mechanical ventilation, not just pneumonia

Streamline the definition using quantitative criteria

• Reduce ambiguity• Improve reproducibility• Enable electronic collection of all variables

Page 29: Ventilator-Associated Events A Patient Safety Opportunity Michael Klompas MD, MPH, FRCPC, FIDSA, FSHEA Harvard Medical School, Harvard Pilgrim Health Care.

Ventilator-associated conditions (VAC)

DatePEEP(min)

FiO2(min)

Jan 1 10 100

Jan 2 5 50

Jan 3 5 40

Jan 4 5 40

Jan 5 8 60

Jan 6 8 50

Jan 7 8 40

Jan 8 5 40

Jan 9 5 40

VAC

Sustained rise in daily minimum PEEP ≥3cm or FiO2 ≥20 points after a period of stable or improving daily minimum PEEP or FiO2

Page 30: Ventilator-Associated Events A Patient Safety Opportunity Michael Klompas MD, MPH, FRCPC, FIDSA, FSHEA Harvard Medical School, Harvard Pilgrim Health Care.

VACVentilator-Associated Condition

IVACInfection-related

Ventilator-Associated Complication

PossiblePneumonia

ProbablePneumonia

Page 31: Ventilator-Associated Events A Patient Safety Opportunity Michael Klompas MD, MPH, FRCPC, FIDSA, FSHEA Harvard Medical School, Harvard Pilgrim Health Care.

Infection-related ventilator-associated complications (IVAC)

DatePEEP(min)

FiO2(min)

Tmin

Tmax

WBCmin

WBCmax

Antibiotic Antibiotic

Jan 1 10 100

Jan 2 5 50

Jan 3 5 40 99.1 99.9 8.4 10.1

Jan 4 5 40 99.9 101.9 9.9 11.2 Linezolid Cefepime

Jan 5 8 60 98.6 102.2 12.1 15.3 Linezolid Cefepime

Jan 6 8 50 98.8 100.3 14.1 17.4 Cefepime

Jan 7 8 40 96.8 99.1 15.0 16.1 Cefepime

Jan 8 5 40 Cefepime

Jan 9 5 40 Cefepime

IVAC

VAC with concurrent abnormal temp or WBC countAND ≥4 days of new antibiotics

Page 32: Ventilator-Associated Events A Patient Safety Opportunity Michael Klompas MD, MPH, FRCPC, FIDSA, FSHEA Harvard Medical School, Harvard Pilgrim Health Care.

Ventilator-associated pneumonia

DatePEEP(min)

FiO2(min)

Gram StainPolys

Gram Stain Epis

Culture

Jan 1 10 100

Jan 2 5 50

Jan 3 5 40

Jan 4 5 40 3+ 0 Klebsiella pneumoniae

Jan 5 8 60

Jan 6 8 50

Jan 7 8 40

Jan 8 5 40

Jan 9 5 40

PROBABLE VAP

IVAC with concurrent purulent sputum (Gram stain neutrophils)and / or positive pulmonary cultures

Page 33: Ventilator-Associated Events A Patient Safety Opportunity Michael Klompas MD, MPH, FRCPC, FIDSA, FSHEA Harvard Medical School, Harvard Pilgrim Health Care.

http://www.cdc.gov/nhsn/VAE-calculator

Page 34: Ventilator-Associated Events A Patient Safety Opportunity Michael Klompas MD, MPH, FRCPC, FIDSA, FSHEA Harvard Medical School, Harvard Pilgrim Health Care.

VAE9.9 events

per 1000 vent days

VAP10.6 events

per 1000 vent days

VS

100 39 109

Muscedere et al. Chest 2013;144:1453

Canadian Critical Care Trials Group ABATE Study11 ICUs, 1330 patients, VAE vs VAP Surveillance

Page 35: Ventilator-Associated Events A Patient Safety Opportunity Michael Klompas MD, MPH, FRCPC, FIDSA, FSHEA Harvard Medical School, Harvard Pilgrim Health Care.

VAE ≠ VAP

Image from http://img.ehowcdn.com/article-new/ehow/images/a07/86/tp/increase-torque-cars-rear-end-800x800.jpg

Page 36: Ventilator-Associated Events A Patient Safety Opportunity Michael Klompas MD, MPH, FRCPC, FIDSA, FSHEA Harvard Medical School, Harvard Pilgrim Health Care.

Qualitative analysis of 153 VAEsRoyal Brisbane & Women’s Hospital, Queensland, Australia

Pneumonia38%

Edema26%

Atelectasis15%

ARDS 6%

Abx + Furosemide 6%

Other 8%Hayashi et al. Clin Infect Dis 2013;56:471-477

Page 37: Ventilator-Associated Events A Patient Safety Opportunity Michael Klompas MD, MPH, FRCPC, FIDSA, FSHEA Harvard Medical School, Harvard Pilgrim Health Care.

VAE = VAP + CHF + ARDS + Atelectasis +Others

Page 38: Ventilator-Associated Events A Patient Safety Opportunity Michael Klompas MD, MPH, FRCPC, FIDSA, FSHEA Harvard Medical School, Harvard Pilgrim Health Care.

Attributable Mortality of VAC versus VAP

Odds Ratio or Hazard Ratio1 10520.

5

USA – 3 centersPLoS ONE 2011;6:e18062

USA – 8 centersCrit Care Med 2012;40:3154

Canada – 11 centersChest 2013;144:1453

Netherlands – 2 centersAm J Resp Crit Care Med 2014;189:947

USA – 2 centersCrit Care Med 2014;ePub

USA – 1 centerInfect Control Hosp Epidemiol 2014;5:502

VAC VAP

Page 39: Ventilator-Associated Events A Patient Safety Opportunity Michael Klompas MD, MPH, FRCPC, FIDSA, FSHEA Harvard Medical School, Harvard Pilgrim Health Care.

VAE Prevention

Page 40: Ventilator-Associated Events A Patient Safety Opportunity Michael Klompas MD, MPH, FRCPC, FIDSA, FSHEA Harvard Medical School, Harvard Pilgrim Health Care.

Strategies for preventing VAEs

Decrease duration of mechanical ventilation

Target the primary

conditions associated with VAEs

Page 41: Ventilator-Associated Events A Patient Safety Opportunity Michael Klompas MD, MPH, FRCPC, FIDSA, FSHEA Harvard Medical School, Harvard Pilgrim Health Care.

Strategies for preventing VAEs

Decrease duration of mechanical ventilation

Target the primary

conditions associated with VAEs

Minimize sedation

Paired SATs and SBTs

Early mobility

Low tidal volume ventilation

Conservative fluidmanagement

Minimize blood transfusions

Page 42: Ventilator-Associated Events A Patient Safety Opportunity Michael Klompas MD, MPH, FRCPC, FIDSA, FSHEA Harvard Medical School, Harvard Pilgrim Health Care.

Conservative fluid management

http://microgravity.grc.nasa.gov/SOPO/ICHO/HRP/ExMC/IVFluids/images/IVbag.jpg

About a third of VACs are due to pulmonary edema

Elevated central venous pressures associated with increased mortality rates

Randomized controlled trial showing conservative fluid management associated with more ventilator-free days compared to liberal fluid management

Boyd et al., Crit Care Med 2011;39:259ARDSnet, NEJM 2006;354:2564

Page 43: Ventilator-Associated Events A Patient Safety Opportunity Michael Klompas MD, MPH, FRCPC, FIDSA, FSHEA Harvard Medical School, Harvard Pilgrim Health Care.

BNP Driven Fluid Management

• Randomized controlled trial of ventilator weaning

• 304 patients randomized to daily BNP levels versus usual care

• Patients randomized to daily BNP levels• More diuretics• More negative fluid balance• Less time to extubation• 50% fewer VAEs 0%

4%

8%

12%

16%

20%VAEs

UsualCare

DailyBNP

P=.02

Mekontso Dessap et al. Chest 2014; ePub ahead of print

Page 44: Ventilator-Associated Events A Patient Safety Opportunity Michael Klompas MD, MPH, FRCPC, FIDSA, FSHEA Harvard Medical School, Harvard Pilgrim Health Care.

Baseline 6 months 15 months 24 months0

20

40

60

80

100

Oral Intubation Closed Suctioning SystemETT with Subglottic Drainage Vent Circuit ChangesHeated Humidifier Changes Suction System ChangesHOB elevation CHG mouthwash

Co

nco

rdan

ce (

% o

f p

atie

nts

)

Canadian Critical Care Trials Group ABATE StudyEnhanced care for vented patients, 11 ICUs, 1330 patients

Sinuff et al. Crit Care Med 2013;41:15-23

Page 45: Ventilator-Associated Events A Patient Safety Opportunity Michael Klompas MD, MPH, FRCPC, FIDSA, FSHEA Harvard Medical School, Harvard Pilgrim Health Care.

Canadian Critical Care Trials Group ABATE StudyEnhanced care for vented patients, 11 ICUs, 1330 patients

Muscedere et al. Chest 2013;144:1453-1460

Baseline 6 months 15 months 24 months0

4

8

12

16VAC Rate (trend P=.05)

VA

Cs

per

100

pat

ien

ts

Page 46: Ventilator-Associated Events A Patient Safety Opportunity Michael Klompas MD, MPH, FRCPC, FIDSA, FSHEA Harvard Medical School, Harvard Pilgrim Health Care.

CDC Prevention Epicenters’Wake Up and Breathe Collaborative

Prospective quality improvement collaborative

Goal: prevent VAEs through less sedation and earlier liberation from mechanical ventilation

Mechanism: increase performance of paired daily spontaneous awakening trials and breathing trials (SATs and SBTs)

12 ICUs affiliated with 7 hospitals

Klompas et al., IDWeek 2014, Abstract 1236

Page 47: Ventilator-Associated Events A Patient Safety Opportunity Michael Klompas MD, MPH, FRCPC, FIDSA, FSHEA Harvard Medical School, Harvard Pilgrim Health Care.

CDC Prevention Epicenters’Wake Up and Breathe Collaborative

63% in SATs

16% in SBTs

81% in SBTs done with

sedatives off

37% in VACs

65% in IVACs

SATs / SBTs VAEs

Klompas et al., IDWeek 2014, Abstract 1236

Page 48: Ventilator-Associated Events A Patient Safety Opportunity Michael Klompas MD, MPH, FRCPC, FIDSA, FSHEA Harvard Medical School, Harvard Pilgrim Health Care.

Ventilator-associated eventsA patient safety opportunity

Broaden Awareness

• VAE surveillance provides hospitals with a fuller picture of serious complications in mechanically ventilated patients

Catalyze Prevention

• A significant portion of VAEs are likely preventable

Reflect and Inform Progress

• VAE surveillance provides an efficient and objective yardstick to track one’s progress relative to oneself and to peers

NEJM 2013;368:1472

Page 49: Ventilator-Associated Events A Patient Safety Opportunity Michael Klompas MD, MPH, FRCPC, FIDSA, FSHEA Harvard Medical School, Harvard Pilgrim Health Care.

Thank You!

Michael Klompas ([email protected])

Page 50: Ventilator-Associated Events A Patient Safety Opportunity Michael Klompas MD, MPH, FRCPC, FIDSA, FSHEA Harvard Medical School, Harvard Pilgrim Health Care.

Next Steps

CUSP for Mechanically Ventilated Patients

Page 51: Ventilator-Associated Events A Patient Safety Opportunity Michael Klompas MD, MPH, FRCPC, FIDSA, FSHEA Harvard Medical School, Harvard Pilgrim Health Care.

Next Steps: Homework

By January 28, 2015

Determine where data needed for VAE surveillance is stored.

Going forward, collect PEEP and FiO2 data for all mechanically ventilated patients in the unit.

Page 52: Ventilator-Associated Events A Patient Safety Opportunity Michael Klompas MD, MPH, FRCPC, FIDSA, FSHEA Harvard Medical School, Harvard Pilgrim Health Care.

Next Onboarding Call: Assessing Patient Safety Culture using the Hospital Survey on Patient Safety (HSOPS)

December 3, 2014 1:00 – 2:00 PM EST

Examine the purpose of collecting HSOPS data.

Review data to be collected for the duration of the project.

Implement a plan to collect data in your unit.

Page 53: Ventilator-Associated Events A Patient Safety Opportunity Michael Klompas MD, MPH, FRCPC, FIDSA, FSHEA Harvard Medical School, Harvard Pilgrim Health Care.

Mark Your Calendar:Upcoming Onboarding Sessions

ACTION DATEOrientation Webinars

4: Assessing Patient Safety Culture using the Hospital Survey on Patient Safety (HSOPS)

Dec 3, 1–2 pm EST

Project Kick-Off Dec 17, 1–3 pm EST


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