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A bundle, a dashboard and lasting pneumonia reduction

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To reduce patient complications related to mechanical ventilation, in 2007 intensive care units at Vanderbilt University Hospital adopted a set of care guidelines called a ventilator bundle. Evidence for the use of such guidelines has come under question in some quarters.

At regular intervals, ICU staff checked off bundle compliance electronically, item by item, and a dashboard showing the status of each bundle element for each patient became the default screen on bedside workstations: green — done; yellow — action needed; red — action overdue.

In the journal Infection Control and Hospital Epidemiology, Thomas Talbot, M.D., M.P.H., and colleagues report that full and uninterrupted bundle compliance increased from 23 percent in August 2007, the first month of implementation, to 83 percent in June 2011, and use of the bundle was associated with significant and sustained decreases in ventilator-associated pneumonia, or VAP, with the combined rate in six ICUs dropping from 19.5 to 9.2 VAPs per 1,000 ventilator-days.

The ventilator bundle and dashboard remain in use today at VUH.

Talbot’s co-authors include Devin Carr, R.N., M.S.N.; C. Lee Parmley, M.D., J.D.; Barbara Martin, M.B.A., R.N.; Barbara Gray, R.N.; Anna Ambrose, M.S.H.A.; and Jack Starmer, M.D.

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