Implementing a ventilator bundle in a community hospital.
BACKGROUND
Mercy & Unity Hospitals of Minnesota implemented the ventilator bundle concept as part of an Institute for Healthcare Improvement (IHI) collaborative on improving care in the intensive care unit (ICU).


METHODS
The two hospitals, which function as a single hospital, have a total of 450 beds, and each has a 20-bed ICU. The IHI bundle was composed of (1) head-of-bed elevation, (2) a daily "sedation vacation" along with a readiness-to-wean assessment, (3) peptic ulcer disease prophylaxis, and (4) deep vein thrombosis prophylaxis. Additional interventions likely complementary to the ventilator bundle were a hand hygiene campaign and an oral care protocol.


RESULTS
Overall compliance with the four bundle elements reached 100% by January 2004. At the end of the collaborative, Mercy's VAP rate decreased from 6.1 to 2.70 per 1000 ventilator days, and Unity's VAP rate decreased from 2.66 to 0 per 1000 ventilator days.


CONCLUSIONS
The all-or-none nature of the bundle may have helped multidisciplinary staff members perceive the project as a systemic change versus a one-time intervention. Staff members needed to implement both structural changes, such as preprinted order sets for ventilator management and sedation, and cultural changes, such as increased collaboration with respiratory therapy.


CONCLUSIONS
The decrease in VAP provides a promising example of the potential of intervention techniques and bundle implementation in a community hospital.
Youngquist
Paul
P
Mercy & Unity Hospitals, Coon Rapids, Minnesota, USA. p_youngquist@msn.com
Carroll
Michelle
M
Farber
Michelle
M
Macy
Deborah
D
Madrid
Pamela
P
Ronning
Jeanine
J
Susag
Amy
A
D003422:Critical Care / Q000379:methods*; D019091:Critical Pathways; D019317:Evidence-Based Medicine; D019983:Guideline Adherence; D006745:Hospital Bed Capacity, 300 to 499; D006764:Hospitals, Community; D006801:Humans; D007362:Intensive Care Units; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D017064:Process Assessment, Health Care; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods*; D015300:Ventilator Weaning / Q000592:standards