CUSP 4 MVP – VAP
Improving Care for Mechanically Ventilated Patients
Early Mobility: Data Feedback and Team
Presentations
ARMSTRONG INSTITUTE FOR PATIENT SAFETY AND QUALITY
Johns Hopkins University
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
April 2015 Cohort 1 Data Webinar
Webinar Objectives
1. Review data results for April 2014 through
March 2015 (four quarters).
2. Discuss how implementing early mobility
protocols and collecting this data has
improved care for mechanically ventilated
patients in your units.
3. Review the process for accessing and
downloading data reports.
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
April 2015 Cohort 1 Data Webinar
Early Mobility:
What Have We Learned to Date?
• Past Content Calls
– Apr 1, 2014: Daily Early Mobility Overview
– Jul 1, 2014: Early Mobility: A Practical Approach
– Nov 4, 2014: Early Mobility and Delirium
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
April 2015 Cohort 1 Data Webinar
Early Mobility:
What Have We Learned to Date?
• Prolonged bed rest and immobility can lead to:
– impaired physical function;
– Cognitive impairment;
– Psychiatric illness.
• Immobility can also lead to cognitive
impairment (e.g. impaired executive function,
inattention).
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
April 2015 Cohort 1 Data Webinar
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
April 2015 Cohort 1 Data Webinar
Daily Early Mobility:
Sedation, Delirium, Mobility
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
April 2015 Cohort 1 Data Webinar
Daily Early Mobility:
Evidence-based Guidelines
• Use the Daily Early Mobility Data Collection
Tool to monitor compliance with evidencebased guidelines such as:
1. performing structured assessments of sedation
levels using a sedation scale (RASS or SAS);
2. performing structured assessments of delirium
using a delirium scale (CAM-ICU or ASE);
3. assisting patients to achieve their highest level
of mobility.
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
April 2015 Cohort 1 Data Webinar
Daily Early Mobility:
Sedation, Delirium, Mobility
1
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
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April 2015 Cohort 1 Data Webinar
Daily Early Mobility:
Data Submission Rates
Number of Cohort 1 Units*
N
Total active hospital units
41
Number of hospital units that have submitted data
23 (56.1%)
* As of April 7, 2015
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
April 2015 Cohort 1 Data Webinar
Early Mobility:
Sedation
• Recommended sedation scales include:
– Richmond Agitation Sedation Scale (RASS)
– Riker Sedation-Agitation Scale (SAS)
• Track the target and actual RASS/SAS scores
for the patient
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
April 2015 Cohort 1 Data Webinar
Daily Early Mobility:
Sedation
Percentage of patients achieving patients achieving RASS/SAS target
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
April 2015 Cohort 1 Data Webinar
% Achieving RASS/SAS target
Calculation
NUMERATOR =
Total number of patient days with Intub/Trach & Mech Vent
marked “Y” (Yes) and:
1) RASS actual score = RASS target score or RASS actual score is less than
or equal to +1 and is greater than the RASS target score
OR
2) SAS actual score = SAS target score or SAS actual score is less than or
equal to 5 and is greater than the SAS target score
DENOMINATOR =
Total number of patient days with Intub/Trach & Mech Vent
marked “Y” and
1) A numeric RASS target score and a numeric RASS actual score
OR
2) A numeric SAS target score and a numeric SAS actual score
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
April 2015 Cohort 1 Data Webinar
Delirium Assessments
• Adult ICU patients should be assessed for
delirium using at least once per shift.
• The Confusion Assessment method for the ICU
(CAM-ICU) is a recommended tool to for
assessing delirium.
Visit https://armstrongresearch.hopkinsmedicine.org/cusp4mvp/processmeasures.aspx for fact sheets
and literature reviews.
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
April 2015 Cohort 1 Data Webinar
Early Mobility:
Delirium
Delirium assessment participation rates
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
April 2015 Cohort 1 Data Webinar
Delirium Assessment
Participation Rates: Calculations
NUMERATOR =
Total number of patient days with Intub/Trach & Mech Vent
marked “Y” (Yes) and:
1) CAM-ICU is marked “P” (Positive) or “N” (Negative)
OR
2) A numeric ASE value is recorded
DENOMINATOR =
Total number of patient days with Intub/Trach & Mech Vent
marked “Y” and:
1) CAM-ICU is marked “P” or “N” or “X” (Not Completed) or “NK” (Not Known)
OR
2) A numeric ASE value or ASE is marked “X” or “NK”
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
April 2015 Cohort 1 Data Webinar
Daily Early Mobility:
Delirium
Percentage of patients screening negative for delirium (as indicated
through CAM-ICU or ASE)
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
April 2015 Cohort 1 Data Webinar
Negative Delirium Screenings (as
indicated through CAM-ICU or ASE) :
Calculations
NUMERATOR =
Total number of patient days with Intub/Trach & Mech Vent
marked “Y” (Yes) and:
1) CAM-ICU is marked “N” (Negative)
OR
2) ASE is less than or equal to 2
DENOMINATOR =
Total number of patient days with Intub/Trach & Mech Vent
marked “Y” and:
1) CAM-ICU is marked “P” or “N”
OR
2) A numeric ASE value is recorded
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
April 2015 Cohort 1 Data Webinar
Daily Early Mobility:
Delirium
Percentage of patient days mobilized out of bed
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
April 2015 Cohort 1 Data Webinar
Percentage of patient days mobilized
out of bed: Calculations
NUMERATOR =
Total number of patient days with Intub/Trach & Mech Vent
marked “Y” and
with highest level of mobility marked (4-standing, 5-transfer
from bed to chair with standing, 6-marching in place, 7-walking)
DENOMINATOR =
Total number of patient days with Intub/Trach & Mech
Vent marked “Y”
4, 5, 6, 7
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
April 2015 Cohort 1 Data Webinar
Summary
Good • Percentage of patients receiving target
RASS/SAS scores is improving
Good
• Percentage of patients receiving
delirium assessments is improving
Good • Delrium rates appear to be on the
decline
Needs • Not much improvement mobilizing
improvement patients out of bed sooner
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
April 2015 Cohort 1 Data Webinar
Let’s hear from some of our
Cohort 1 teams!
Kassie Basnight,
RN, BSN
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
Emily Pasola,
MSN, RN, CNL
April 2015 Cohort 1 Data Webinar
Next Steps
• Continue using a protocol to achieve the
highest level of mobility possible for patients.
• Continue using the Daily Early Mobility Data
Collection Tool to track progress.
• Continue entering data into the data portal
receive data reports and monitor improvement.
• Attend the May 5, 2015 Cohort 1 Content
Webinar (Topic: The 4 Es of Early Mobility &
Presentations from Teams on Early Mobility
Implementation).
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
April 2015 Cohort 1 Data Webinar
Helpful Links
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•
Early Mobility Toolkit
https://armstrongresearch.hopkinsmedicine.org/cusp4mvp/earlymobility.as
px
•
Data Measures Definitions and Formulas
(Scroll to bottom of page and click on “Data Measures Definitions”)
https://armstrongresearch.hopkinsmedicine.org/cusp4mvp/datatools.aspx
•
CUSP 4 MVP-VAP Data Portal
https://armstrongresearch.hopkinsmedicine.org/MyTools.aspx
•
Early mobility assessment and treatment steps from SCCM ICU Liberation
project
http://www.iculiberation.org/Mobility/Pages/default.aspx
CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
April 2015 Cohort 1 Data Webinar
How to Access Data Reports
•
•
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Go to the CUSP 4
MVP – VAP
Homepage:
https://armstrongres
earch.hopkinsmedic
ine.org/cusp4mvp.a
spx .
Click on “Data Entry
and Reports.”
CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
April 2015 Cohort 1 Data Webinar
•
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Log in.
CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
April 2015 Cohort 1 Data Webinar
•
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Click on “My
Network
Performance.”
CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
April 2015 Cohort 1 Data Webinar
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•
Choose the time period that your heart desires.
•
Choose the app that you would like to view!
CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
April 2015 Cohort 1 Data Webinar
There are several Early Mobility reports that are
available for you to view. They include:
• Adverse event rates
• Delirium assessment participation rates
• RASS/SAS Target percentages
• CAM-ICU/ASE percentages
• % patient days mobilized out of bed
•
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Click “View Chart” under the measure that you would like to
view. In this example, we are looking at Delirium Assessment
Compliance Rates.
CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
April 2015 Cohort 1 Data Webinar
•
A graph will
appear on the
bottom.
•
Click the PDF
icon to
download the
report.
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
April 2015 Cohort 1 Data Webinar
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
April 2015 Cohort 1 Data Webinar
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CUSP 4 MVP – VAP: Improving Care for Mechanically Ventilated Patients
April 2015 Cohort 1 Data Webinar