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Web site spotlight: Lower VAP rates by using electronics

Staff Development Weekly: Insight on Evidence-Based Practice in Education, May 15, 2009

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University of Pennsylvania Health System (UPHS) in Philadelphia lowered its ventilator-associated pneumonia (VAP) rates by using an electronic ICU (eICU) to monitor patients.

The eICU contains three surveillance stations: two for each of the nurses and one for the physician. There is a smaller setup for the data coordinator as well. A surveillance station contains six computer screens, each displaying pertinent data, pictures, or video, mounted on a desktop. A phone and alarms are attached.

Joseph DiMartino, BSN, RN, outcomes coordinator at the Penn E-lert eICU at UPHS, explains that bedside caregivers often set patient alarms so they only go off in an emergency and are not ringing all day and becoming a distraction. The eICU’s system is set to be alerted whenever there is a 20% or higher change in a vital sign, and the eICU staff can alert the bedside caregiver if necessary.

Currently, the eICU is staffed by two nurses from 11 a.m. to 11 p.m. and one nurse from 11 p.m. to 11 a.m. Additionally, a physician monitors the eICU from 7 p.m. to 7 a.m. The data coordinator’s shifts vary.

The eICU surveillance team is trained to watch for the care techniques identified in the Institute for Healthcare Improvement’s bundle of care for preventing VAP. This means head-of-bed elevation between 30º and 45º and prophylaxis for prevention of stress ulcers and deep vein thrombosis. The bedside caregivers are responsible for measuring the patient’s readiness to extubate and ensuring that daily sedation holidays have been implemented.

Since implementing the eICU, UPHS has reduced VAP rates from 17 in 2006 to 9 in 2007.

Editor’s note: This excerpt was adapted from “Health system lowers VAP rates with eICU” found in the Reading Room at www.StrategiesForNurseManagers.com. Get a free trial membership that will give you 30 days to test drive all the exciting features on the Web site.

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