Page 128 - HA Convention 2015

Service Priorities and Programmes Free Papers

SPP4.5 Clinical Safety and Quality Service II 16:15 Room 221

Monday, 18 May Can Nurses’ Compliance to Ventilator Care Bundle Help to Prevent Ventilator Associated Pneumonia in Intensive

Care Unit?
Mok CM 1,3, Chan P 2,3, SO HM 1,3, Chiu MC 1,3, Tang S 2,3, Li SC 1, Wong PM 1,3, Lau L1,3, Kwok N 1,3, Lee A 2,3
1Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital,
2Cardiac and Intensive Care Unit, Ruttonjee and Tang Shiu Kin Hospitals,
3Quality Improvement Project Group on Prevention of Ventilator-associated Pneumonia, Hong Kong East Cluster,

Hospital Authority, Hong Kong

Introduction

Ventilator associated pneumonia (VAP) is the commonest yet mostly preventable infection in mechanically ventilated patients.
Successful control of VAP can save hospitalisation cost. Evidence supports the reduction of VAP by strict compliance to
ventilator care bundle (VCB). The Hong Kong East Cluster (HKEC) has been actively promoted the use of VCB to prevent VAP
since 2012. A cluster-based compliance audit on ventilator care bundle was conducted in 2013 and 2014.

Objectives

(1) To study nurses’ compliance on ventilator care bundle; (2) to provide feedback to nurses’ performance; and (3) to
recommend follow-up actions for improvement.

Methodology

Led by the Nurse Consultant of Intensive Care, a cluster-based quality improvement project on prevention of VAP was
launched in 2012 in some critical care areas of HKEC. A locally specific ventilator care bundle was developed after literature
review and referencing to the Hong Kong ventilator care bundle developed by Centre for Health Protection. To facilitate
nurses’ and doctors’ compliance to the VCB, a ventilator care bundle checklist was designed and placed at each patient’s
bedside in ICU. An audit form was then developed with 10 elements included in the VCB checklist. A convenient sampling
method was used to collect data. A total 80 samples were collected with 60 and 20 samples from ICU of Pamela Youde
Nethersole Eastern Hospital (PYNEH) and Ruttonjee and Tang Shiu Kin Hospitals (RHTSK) respectively. The audit process
was conducted through clinical observation of nursing practice and checking of medical records by nurse auditors in the
unit. Compliance results were then fedback to staff. Recommendations were made to those elements with poor compliance
and were diligently followed-up by the VAP prevention team.

Results

The rate of full (100%) compliance to VCB increased dramatically from 51% (41/80) in August 2013 to 89% (71/80) in October
2014. Furthermore, the overall compliance to each element of the VCB achieved 95%. There was significant improvement
in compliance with keeping head of bed elevation at 30° and drainage of condensate from ventilator circuit after intensive
reinforcement. Moreover, the average VAP rate (per 1,000 ventilator days) from ICU of PYNEH decreased significantly
from 19.1 in 2012 to 9.6 in 2013 and further to 6.8 in 2014. For Cardiac and Intensive Care Unit of RHTSK, although there
was an increase in the average VAP rate from 6.3 in 2013 to 13.8 in the first four months in 2014 due to proper reporting
of the new practice, the VAP rate subsequently decreased to 6.4 for the rest of the time in 2014 after full promulgation of
VCB. Compliance audit serves as a measure to assure that nurses’ strict compliance to ventilator care bundle does help to
maintain high quality care to ventilated patients in ICU and hence to reduce VAP ultimately.

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