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A lot of my communications often focus on
the challenges of health care nationally as well as locally. It
gives me great pleasure when I have the opportunity to share
small and large miracles, as well as heroes among us throughout
the entire Lee Memorial Health System.
Today, I’d like to reinforce a major success story that shows
how teamwork and a willingness to use evidence based research
can make a difference in the lives of our patients.
Physicians and staff members in the Intensive Care Unit at Cape
Coral Hospital for more than two years have been consistently
using relatively simple treatment methods to prevent any
occurrence of ventilator-associated pneumonia.
In fact, for more than two years there have been no incidents of
ventilator-associated pneumonia in the ICU at Cape Coral
Hospital. This is not an insignificant accomplishment. It places
Cape Coral ICU staff among the leaders in the nation in this
important quality initiative!
Ventilator-associated pneumonia, or VAP, has the highest
mortality rate of any hospital-acquired infection at 14 percent.
On average, a patient with VAP stays in the ICU four to seven
days longer which obviously, at best, puts a strain on the
patient and his or her family members and can cause
complications with other treatments. VAP also costs about
$40,000 per patient to treat, which is money out of the pockets
of our patients and the health system. It also ties up critical
staff and critical care beds.
The ICU at CCH, like our other ICUs, has always been vigilant
about monitoring for VAP. However, about four and a half years
ago, the ICU at CCH joined the Institute for Healthcare
Improvement’s Critical Care collaborative to focus on reducing
occurrences of VAP in ICUs.
The Institute for Healthcare Improvement, more commonly known as
the IHI, is a nonprofit organization founded in 1991 that has
become a leader in the improvement of health care practices not
only in the U.S. but in many participating nations throughout
the world. Dr. Marilyn Kole has been LMHS’ lead physician in
working with IHI on ICU related initiatives. Annette Forlenza,
RN, is the nursing director of the CCH ICU who helped lead this
success story on a daily basis.
The IHI’s treatment protocol for VAP focuses on a “care bundle”
with five very specific steps:
• Elevating the head of the patient’s bed 30 degrees.
• Providing mouth care every two hours.
• Preventing deep vein thrombosis, or DVT, which is the
formation of a blood clot in a deep vein.
• Preventing peptic ulcer disease, or PUD, which is the
formation of painful ulcers in the lining of the stomach or
small intestine.
• Giving patients a “sedation vacation,” which means evaluating
patients regularly to begin weaning them off sedatives as soon
as possible.
As Dr. Larry Antonucci, Chief Administrative Officer for CCH,
recently pointed out, none of the steps in the care bundle is
particularly high-tech. They are basic bedside nursing
techniques that have not always been followed religiously in
hospital ICUs. However, once adopted on a consistent basis as
the ICU’s nursing staff and respiratory therapists at CCH have
done, the results are stunning.
The ICU at CCH is not only beating the national average for VAP,
but only one other hospital out of the 25 participating in the
IHI’s Critical Care collaborative for VAP has gone two years
without an occurrence.
All of the LMHS ICUs are practicing the IHI’s care bundle for
VAP, and the entire System is also focusing on reducing
central-line infections and urinary tract infections. There have
been significant reductions in both types of infections
system-wide.
I’m proud to be able to share such a wonderful and powerful
story with our community. Lee Memorial Health System employees
are truly leading the nation in better patient care initiatives.
Congratulations to the entire Cape Coral Hospital Intensive Care
Team. It speaks volumes of your talent and strength to do the
right things every day and every night on behalf of the patients
you serve.
Peace,
Jim Nathan, LMHS President
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