Improve Effectiveness in Trauma Teamwork

On average, each Ventilator-Associated Event (VAE) is anticipated to increase the length of stay in the Intensive Care Unit (ICU), resulting in potential adverse events and cost to the organization. The Center for Disease Control (CDC) defines VAE as the increase of daily minimum positive end-expiratory pressure (PEEP) and fraction of inspired oxygen (FiO2) values, after a baseline period of patient stability or improvement on the ventilator (CDC, 2018). Standard endotracheal tube designs have led to the incidence of VAE because of the accumulation of subglottic secretions in the trachea. Untreated VAE can later result in Ventilator Associated Pneumonia (VAP). A clinical nurse leader (CNL) focuses on all clinical elements to reduce subglottic secretions by leading a practice improvement project in the Level II Trauma Center of a mid-sized suburban community hospital with assistance of a multidisciplinary team called Prevent VAE Team. The multidisciplinary team will assess the incidence of VAE and aim to evaluate interventions that increase adherence to evidence-based practices to reduce VAP. A retrospective case review reveals that the pattern and prevalence of VAE is primarily related to the presence of the standard endotracheal tube, which causes accumulation of subglottic secretions in the trachea, on patients hospitalized in the ICU setting. Based on the observed variation in the ICU microsystem, placing subglottic endotracheal tubes (SETT) into the operating room (OR) and emergency medical system (EMS) settings appears to address the root cause of excessive VAE in the ICU setting. Providing front line staff feedback, debriefing, and coaching brought awareness to achieve the long-term goal of reducing VAE to zero. Over a 6-month period, this improvement project resulted in reduction of VAE from 31 ICU events (six attributed to trauma patients) to three ICU events (0 attributed to trauma patients). The improvement project supports the creation of a culture of safety, continuous improvement, evidence-based practice, and cost avoidance in the ICU. The organizational commitment to this project will extend over a 1-year period