CUSP: Improve Teamwork and CommunicationOn September 9, 2019 by Raul Dinwiddie
Yeah. So as you know we’ve all been really looking at our infection rates at the hospital. As for us here in the unit, one of the rates we’ve been looking at is our ventilator-associated pneumonia. We took a closer look at that rate specifically with infectious disease. Folks were concerned because it was pretty high. Yeah, our faculty group was concerned about the same thing. Yeah, I thought our rates were a bit high, but I hadn’t seen the actual numbers. Well, clearly our rates are higher than other units, and I’ve actually seen data which suggests that our rates are higher than the state average for similar ICU, so yes, we do need to get to work and reduce our VAP rate. Speaking for the respiratory therapist, we absolutely agree. We’ve been implementing the Ventilator Bundle to help prevention infection by elevating the head of the bed, doing daily sedation vacations, making daily assessment of the patient’s readiness for extubation. Yeah, right, I’ve been observing rounds and I noticed that not all components of the Bundle are being followed. For example, not everyone is getting a sedation vacation. I may have an idea. We all use daily goals now. Maybe what we need to do is talk about the components of the Ventilator Bundle when we do our rounds and review our goals for the day. I am the first to admit, I have really not stressed the use of the Daily Goals Checklist. I’ve just not made it a priority for our team, but I could personally reintroduce this checklist and make it the focal part of rounds. I also think it would be important to share this information with the patient’s family members or their caregivers. Yeah. I think that’s a great idea. So earlier we were talking about increase rates of ventilator-associated pneumonia in our unit. I know you’re all familiar with the Daily Goals Checklist, but I don’t think we’ve been using it the best way we know how, especially when rounding with our team. So I really want us to start using it more regularly. We know how to reduce these infections. It’s a really good idea, because the components of the Ventilator Bundle are included on the checklist. Yeah, they’re all right there in the list. So we can determine the daily timing of our ventilated patient’s sedation vacations. That’s right, so we really need to start using this checklist today, and we can talk about it with the patients and their families when we do our rounds. Well, thank you Mr. Jones for having our entire team in your room today. I’ll be back later this afternoon to see you. Well, rounds are a much better than when I was here a couple of weeks ago. I really like using this Daily Goals Checklist, and I’ve spoken with several colleagues and they’ve started to use it much more regularly. Also family members really seem to appreciate the amount of information we’ve been sharing with them. You know, it’s important to keep family members and caregivers informed about the patient and it’s also helpful for us. Yesterday a family member informed the nurse that the head of her father’s bed had accidentally been left down after he had a portable chest x-ray. So yes, it’s been very helpful for the entire team. And Tom, I think you’re going to be really happy to know that we’ve been doing much better on the daily sedation vacations for all patients. Oh, that’s great! Well, let’s review our goals for today. We talked about when Mr. Rivers’ catheter would come out. We talked about his nutrition. Maria, thanks for reminding us about the change in his heparin regime. Let’s see, let’s go back and review Mr. Jones’ sedation. Yeah, I’d like to talk about the time and the sedation vacation for Mr. Jones today. I know we’re going to get a couple of new patients to the unit from the OR and then later on this morning it’s going to be really hectic. That’s a good point! How about 2 p.m. for the sedation vacation? Yeah, I can be here then. Okay. So we’re on the same page there, the sedation vacation for Mr. Jones will be at 2 p.m. this afternoon. Angela and I would be right here at 2 o’clock to make sure that happens. Okay. In the meantime I’ll update Mr. Jones’ wife and daughter about our plan. Well, that’s great, Angela! This is good! I think this helps us reach our daily goals, which means patients are discharged sooner, and I think we’re going to see a decrease in our ventilator-associated pneumonia rates. That’s great! Shall we?