title: [Applying Team Resource Management to the Reduction of Ventilator-Associated Pneumonia in the Intensive Care Unit].
abstract: OBJECTIVE
  Ventilator-associated pneumonia (VAP) is a common healthcare-associated infection in the intensive care unit. The average VAP rate was .128% in our unit during 2011. Therefore, we designed a project to identify relevant problems, including: inadequate knowledge about VAP care, incorrect techniques for sputum suction, patient head elevation < 30~45 degrees, ventilator humidifier installed with water equipment designed without water-resistant barriers, failure to change the resuscitator and small-volume nebulizer regularly, and possible cross-contamination between respiratory-care devices.
  
  
  OBJECTIVE
  We targeted a VAP rate decrease from the current .128% to less than .1%.
  
  
  METHODS
  The improvement measures implemented included team resource management (TRM) with VAP education, promotion, a written reminder regarding sputum accumulation sites, instruction to elevate the head of patients to an appropriate height, introduction of an auto-stop water adding system, and regular changes of related devices at assigned positions.
  
  
  RESULTS
  The VAP rate decreased from .128% to .065%.
  
  
  CONCLUSIONS
  The risk identification and associated TRM project improved teamwork and the quality of care in the ICU.
authors.affiliation: Medical Intensive Care Unit, Feng-Yuan Hospital of the Ministry of Health and Welfar, Taiwan, ROC.
authors.forename: Ching-Wei
authors.initials: CW
authors.lastname: Chen
authors.affiliation: Medical Intensive Care Unit, Feng-Yuan Hospital of the Ministry of Health and Welfare, Taiwan, ROC.
authors.forename: Chia-Ling
authors.initials: CL
authors.lastname: Lin
authors.affiliation: Medical Intensive Care Unit, Feng-Yuan Hospital of the Ministry of Health and Welfare, Taiwan, ROC.
authors.forename: Hua-Ting
authors.initials: HT
authors.lastname: Chang
authors.affiliation: Medical Intensive Care Unit, Feng-Yuan Hospital of the Ministry of Health and Welfare, Taiwan, ROC.
authors.forename: Chau-Rong
authors.initials: CR
authors.lastname: Hsu
authors.affiliation: Department of Nursing, Feng-Yuan Hospital of the Ministry of Health and Welfare, Taiwan, ROC. h1229a@fyh.mohw.gov.tw.
authors.forename: Hui-Hu
authors.initials: HH
authors.lastname: Liu
mesh_terms: D006295:Health Resources; D006801:Humans; D007362:Intensive Care Units; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control*
keywords: intensive care; team resource management; ventilator-associated pneumonia