ICUs at Mercy & Unity Hospitals win safety and innovation awards
FRIDLEY, Minn. 01/17/2005--
Intensive Care Unit staffs at Mercy & Unity Hospitals are doing what health professionals thought could not be done. They are close to eliminating a costly and sometimes deadly infection among intensive care patients.
The infection is ventilator associated pneumonia, also known as VAP. Patients who require mechanical breathing assistance risk developing VAP, and their risk increases with time on the ventilator.
In January 2003, Mercy & Unity ICU nurses, physicians, respiratory therapists and pharmacists began using new practice guidelines in their daily work. Over 18 months, VAP rates at both hospitals decreased 50 percent.
Because of their success, Mercy & Unity Hospitals have received two important awards from the Minnesota Hospital Association – the 2004 Patient Safety Award and the 2004 Patient Care Innovation Award.
VAP infections are measured as the number of infections per the number of hours patients are on ventilators. While the national benchmark for VAP is 6 infections per 1,000 ventilator days, at the end of the study period, Unity’s rate was 1.09 and Mercy’s was 3.01. The most recent VAP rates are even lower: Unity, 0.85 and Mercy, 2.4.
In human terms, during the study period, Unity went 448 days without a VAP and as of Sept. 30, 2004, Mercy had gone six months without this form of pneumonia.
“The goal in our ICUs is to not only reduce VAP, but eliminate it,” said Deborah Macy, director of nursing for Emergency and Critical Care.
The ICU teams found that the consistent use of relatively simple procedures, such as brushing patients’ teeth and frequent hand cleaning, dramatically reduced VAP. They also put into practice a concept known as “ventilator bundle,” a grouping of five low-tech interventions demonstrated to reduce length of time on the ventilator:
1) All patients received medication to prevent stress ulcers in the stomach and intestines.
2) All patients received medication to prevent blood clots that can form during inactivity.
3) The head of each patient’s bed was elevated to prevent mouth secretions from flowing into the trachea.
4) Instead of waiting for a physician to make the call, nurses checked every day to see if patients were ready to be weaned from the ventilators.
5) Instead of removing patients’ sedation medication all at once, medication dosages were gradually reduced each day, allowing for better neurological examinations.
The Minnesota project has national significance, because VAP rates in hospitals across the country range from eight to 28 percent. And many of the patients die – mortality rates range from 24 to 50 percent.
Also notable is the cost to the health care system. Each VAP adds an estimated $40,000 to the cost of a patient’s care.
Mercy & Unity Hospitals, located in Coon Rapids and Fridley, are non-profit hospitals that serve the northern Minneapolis-St. Paul metropolitan area. The hospitals, which are part of Allina Hospitals & Clinics, cared for nearly 230,000 patients in 2004. More information is located at www.mercyunity.com.
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