Welcome to the February Issue of HIIN The Know ! This month we focus on ventilator-associated events (VAEs) complications that can occur in patients receiving mechanical ventilation. These complications include: ventilator-associated pneumonia (VAP), sepsis, acute respiratory distress syndrome (ARDS), and pulmonary embolism. Mortality rates in patients with acute lung injury secondary to mechanical ventilation have been estimated to range from 24 percent in persons 15–19 years of age to 60 percent for patients 85 years and older. 1 VAE is also associated with higher healthcare costs and extended lengths of stay. 2 VAE surveillance has been captured using the National Healthcare Safety Network (NHSN) since 2013. While the data has shown some signs of improvement, particularly with infection-related ventilator-associated condition (IVAC) and possible ventilator-associated pneumonia (PVAP), there is still work to be done. To date, key improvement strategies have been aimed at decreasing the duration of mechanical ventilation, by using the ABCDEF 3 bundle developed by the Society of Critical Care Medicine. To support hospitals, HSAG HIIN developed a VAE observation tool to allow easy monitoring of the ABCDEF Bundle Compliance as well as focusing on other best practices such as hand hygiene, head of bed elevation, endotracheal tube with sub-glottic suction, oral care, patient and family engagement, and daytime/nighttime lighting as appropriate for VAE prevention. For more information on the ABCDEF bundle, please visit https://www.sccm.org/ICULiberation/ABCDEF-Bundles .   Let HSAG HIIN help identify the best tools and strategies to fit your hospital's needs so together we can reduce VAEs. Please reach out to your quality advisor to discuss how to review your data reports, identify areas of opportunity, and continue to improve care in the communities you serve. References: Rubenfeld GD, Caldwell E, Peabody E, et al. Incidence and outcomes of acute lung injury. New England Journal of Medicine. 2005; 353:1685–93. Esteban A, Anzueto A, Frutos F, et al. Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. Journal of the American Medical Association. 2002; 287:345–55.  Society of Critical Care Medicine: ICU Liberation: ABCDEF Bundle: Available at: https://www.sccm.org/ICULiberation/ABCDEF-Bundles. Accessed on: January 16, 2020.

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HSAG HIIN Hospitals' VAE Progress

The information below indicates the percentage of HSAG HIIN hospitals reporting VAEs and the number of patient harms for VAEs, IVACs, and VAP.

Improvement Tools and Resources

HSAG HIIN—VAE Field Guide This guide contains VAE information on the harm impact of VAEs, the VAE measure, known improvement strategies, patient and family education strategies, and resources. Click here to view the field guide.

HSAG HIIN—VAE Reporting Presentation This how-to presentation describes how to report your VAE data by using examples and specific definitions to determine a VAE. Click here to view the presentation.

HSAG HIIN — VAE Observation Tool This tool helps hospitals monitor their adherence to the best practice bundles to reduce VAEs. Click here to view the tool.

AHRQ—Toolkit to Improve Safety for Mechanically Ventilated Patients This Agency for Healthcare Research and Quality (AHRQ) toolkit helps hospitals make care safer for mechanically ventilated patients in intensive care units. Click here to view the toolkit.

IHI—How-to Guide: Prevent VAP This how-to guide from the Institute for Healthcare Improvement (IHI) examines evidence-based care components for VAP, describes how to implement these interventions, and includes recommended measures to gauge improvement. Click here to view the guide.

HRET HIIN — Change Package This Health Research & Education Trust (HRET) HIIN change package contains strategies to improve patient quality care and reduce VAEs. Find guidance on improving strategies, change concepts, and specific action items. Click here to view the change package.

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The Data Advantage Corner

Reminder—Hospital Readmissions Report Available The hospital readmissions report provides a summary of your hospital’s Medicare Fee-for-Service (FFS) readmissions data through Q2 2019 and provides overall and stratified readmission rates—allowing your hospital to identify key areas of focus. To find your hospital’s readmission report, please log in to the HSAG HIIN Secure Data Portal and select the Reports tab.

Upcoming Events and Education

Glycemic Peer Group Part II Wednesday, February 12, 2020 12 noon to 1 p.m. PT

CHF Patients Part II Friday, February 14, 2020 8 a.m. to 12 noon PT *CHF = Congestive Heart Failure

Sepsis Peer Group: ICU Liberation Bundle Wednesday, February 19, 2020 9 to 10 a.m. PT *ICU = Intensive Care Unit

HAPI Peer Group Tuesday, February 25, 2020 12 noon to 1 p.m. PT *HAPI = Hospital-acquired pressure injury

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News and Networking

Tell us about a best practice or noteworthy story you would like to share with the HSAG HIIN community. What you do makes a difference, so please share! VAE Harm Prevention Is a Team Support Oak Valley Hospital District in Oakdale , California, created strategies to help conduct surveillance and eliminate VAEs. Click here to view the strategies and best practices used by Oak Valley Hospital District.

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