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JOURNAL ARTICLE

Using a bundle approach to improve ventilator care processes and reduce ventilator-associated pneumonia

Roger Resar, Peter Pronovost, Carol Haraden, Terri Simmonds, Thomas Rainey, Thomas Nolan
Joint Commission Journal on Quality and Patient Safety 2005, 31 (5): 243-8
15960014

BACKGROUND: A "bundle" of ventilator care processes (peptic ulcer disease prophylaxis, deep vein thrombosis prophylaxis, elevation of the head of the bed, and a sedation vacation), which may also reduce ventilator-associated pneumonia (VAP) rates, can serve as a focus for improvement strategies in intensive care units (ICUs). Between July 2002 and January 2004, teams of critical care clinicians from 61 health care organizations participated in a collaborative on improving care in the ICU.

METHODS: ICU team members posted data monthly on a Web-based extranet and submitted narrative descriptions describing the changes tested and the strategies implemented.

RESULTS: For the 35 units that consistently collected data on ventilator bundle element adherence and VAP rates, an average 44.5% reduction of VAP was observed.

DISCUSSION: The goal-oriented nature of the bundle appears to demand development of the teamwork necessary to improve reliability. The observations seem sufficiently robust to support implementing the ventilator bundles to provide a focus for additional change in ICUs.

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