CNHI News Service
Archbold Memorial Hospital has seen its share of medical attention—both in caring for patients as well as recognition for being leaders in adoption of new technologies, launching surgical innovations and delivering quality outcomes.
It’s the latter that’s getting national attention presently.
Recently, VHA Inc., the national health care network that works to improve performance and efficiency in clinical, financial and operational management, chose to adopt Archbold’s Ventilator-Associated Pneumonia (VAP) protocols as the only evidence-based national “blueprint” for how to avoid the condition in hospitals. According to VHA, Archbold’s methods in avoiding VAP are the Leading Practice Blueprint®, an endorsed model which hospitals across the country should adopt.
The Centers for Disease Control classify VAP as pneumonia occurring more than 48 hours after patients have been intubated (the introduction of a tube in the trachea) and receiving mechanical ventilation. While critically ill patients experience a life-threatening illness, they commonly contract ventilator-associated pneumonia. This infection increases morbidity—and likely mortality—as well as the cost of health care. People who are on mechanical ventilation are often sedated and are rarely able to communicate. As a result, healthcare workers must be proactive in maintaining optimal lung function with limited patient participation, including steps for prescribed mouth care, head of bed elevation and adjustment of ventilator parameters.
Between 8 and 28% of patients receiving mechanical ventilation are affected by VAP. VAP can develop at any time during ventilation, but occurs more often in the first few days after intubation. This is because the intubation process itself increases the risk for developing VAP.
For Archbold to be recognized, VHA applied industry-standard criteria in the analysis of leading practice indicators to determine if Archbold met the guidelines for a leading practice. This past March, a team of VHA experts visited Archbold to study and document the VAP prevention processes. Archbold’s team collaborated with VHA’s knowledge transfer team to develop a Leading Practice Blueprint® that mapped out each step in the process. Not only are the clinical processes showcased, but also the cultural factors and social patterns that influence performance to ensure the most success in transferring the knowledge for other hospitals to implement.
During a measured period—2012 and 2013—Archbold treated patients without a single VAP, an accomplishment VHA found significant enough to contact the hospital to inquire further about how they achieved this success. Over the two year period, 855 patients spent over 5,938 days on a ventilator and avoided contracting VAP.
“VHA’s approach is unique in our industry. It focuses on conveying complex information in a simple, unique way. Archbold’s team participated in a process that will play a role in shaping leading practices for other hospitals nationwide,” said Remar Thorsness, senior director, knowledge and blueprint practice at VHA.
“It’s a prestigious honor,” said Robin Godwin, RN, Archbold’s director of critical care and a key figure on the team.
Godwin helped lead a team that developed the protocol, which included staff from critical care, respiratory therapy, infection control, pharmacy, trauma and clinical informatics.
Through this unique collaboration, multi-disciplinary teams aligned around the common goal of reducing VAP to non-existence, not knowing the roles they were playing was creating the protocols that became one for others to follow. “The ability to reach out and work together as a team helped us overcome barriers,” said Godwin. “From physicians to front-line staff, the sharing of input and the alliance that grew between departments made the difference. Independent attempts to reduce VAP were made before, but working together was the ultimate key to success.”
“Sharing leading practices is one of the keys to improving health care across the nation. Archbold’s willingness to share their knowledge and processes will help other hospitals move along the path to higher levels of patient experience, outcomes and lower cost of care,” said Steve Miff, PhD, a senior vice president at VHA. “This type of knowledge transfer gives member hospitals an advantage in adopting the kind of quality and cost improvements that are now required in the rapidly changing health care environment.”
“When you’re focused on delivering the best care to every patient, every time, eventually you reach milestones like these,” said Archbold’s Chief Nursing Officer Amy Griffin. “But we don’t do it for the recognition; we do it because it’s the right thing to do.”
Long-term, the VAP team wants to continue to sustain the zero-VAP rate, and the structure is in place to make it happen. Recurring evaluation of various clinical protocols and electronic documentation and process improvement will be important, as will daily patient visits known as “rounding.” Internal oversight committees of multi-disciplinary teams will ensure accountability of a routine delivery of care to the point that following the protocols are automatic.
“Like many other behaviors we’re trying to improve, these protocols are successful because we’ve hardwired them so our clinical team delivers leading practice care automatically,” said Godwin. Also, the structure and foundation for sustaining these care improvements is strong. And it’s especially gratifying to know that other hospitals will be encouraged to duplicate our processes.”