Sustaining VAP Bundle Compliance in the ICU: A Model of CQI

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Clinical PI

Jamie El Harit, RN
Business Transformation Specialist
Sisters of Saint Francis Health Services, Inc

With the implementation of Lean Six Sigma process improvements in clinical settings, sustainability of original pilot results has proven to be challenging in a not-for-profit community hospital setting. This session will focus on the impact of a LSS project aimed at reducing ICU length of stay and improving quality outcomes for mechanically ventilated patients. The challenges in maintaining process measures and staff compliance will be discussed.

In 2005 the School of Industrial Engineering Technology at Indiana University Purdue University Indianapolis and the Sisters of Saint Francis Health Services, Inc, partnered to develop a Lean Six Sigma program in healthcare. Saint Margaret Mercy in Hammond and Dyer Indiana implemented an ICU LOS project aimed at delivering evidence-based care to all patients in the ICU on mechanical ventilation. Standardized protocols were developed and the initial results demonstrated dramatic reduction in total ventilator days, total ICU LOS, and the units ventilator associated pneumonia rate (VAP). For various reasons including: difficulty transitioning the project ownership during the Control phase from facilitator to process owner, weakening staff engagement in the project, multiple management changeovers within a two year period and initial absence of a clinical nurse specialist, the project outcomes deteriorated. ICU LOS went back up, staff compliance to the protocols and bundles decreased and the VAP rate was also affected. Leadership in the ICU, as well as the LSS project leader identified the issues to sustainability and the need for a stronger control plan. A VAP committee was started to focus, initially, on the failure modes of the current process and raise the project metrics back to the threshold. This team has now been able to identify further improvements in the care of the mechanical ventilated patient and has been able to develop the initial VAP project into one of continuous process and quality improvement.