NYSPFP HIIN: VAE/Delirium Prevention

Non-pharmacological Interventions to prevent and manage delirium

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May 30, 2017

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AgendaTopic SpeakerWelcome and Introductions NYSPFP Staff

Surviving the ICU: A perspective from both sides of the bed

Dr. Alison ClayProfessor Critical Care and SurgeryDuke University Medical CenterDurham, North Carolina

An Ounce of Prevention: Non-pharmacologic Care for Delirium

Dr. Tammy HshiehBrigham and Women's Hospital, Division of AgingBoston, Massachusetts

Delirium Prevention: patient & hospital-wide benefits

Dr. Jeffrey T. BergerChief of the Division of Palliative Medicine and BioethicsMaureen Gaffney, MHS, PA-C, RNSenior Vice President, Clinical OperationsNYU Winthrop Hospital

Hospital Questions and Discussion Hospital Participants Tools and Resources/Next Steps NYSPFP Staff

NYSPFP Approach to VAE/Delirium Reduction

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VAE/Delirium Goal and Approach Goal: To reduce ventilator-associated events (VAE) by 20% and the incidence of iatrogenic delirium in critical care patients.

Hospitals will focus on spreading interventions to reduce VAE and delirium throughout critical care units. NYSPFP will support hospitals in implementing evidence based strategies including:

○ Implementation of the ABCDEF Bundle○ Implementing non-pharmacological interventions to prevent and

manage delirium○ VAE:

○ High Reliability in application of the VAP bundle○ Implementing emerging interventions aimed at reducing VAE

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ABCDEF Bundle Components

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VAE/Delirium Measures for NYSPFP

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NYSPFP MeasureCategory

Measure(All ICU patients included in prevalence study)

Delirium Process Pain assessment utilization rate (Manual Collection)Suggested Tool(s): CPOT or BPS

Delirium Process Agitation assessment utilization rate (Manual Collection)Suggested Tool(s): RASS or SAS

Delirium Process Delirium assessment utilization rate (Manual Collection)Suggested Tool(s): CAM-ICU or ICDSC

Delirium Outcome Prevalence rate of ICU patients meeting the diagnostic criteria for delirium as measured by a delirium assessment (Manual Collection)

VAE Process Ventilator Utilization Ratio

VAE Outcome VAE Rate per 1,000 Ventilator Days (NHSN)

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PAD Assessment Tools

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NYSPFP VAE Rate

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NYSPFP IVAC Plus Total VAP Rate

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NYSPFP Ventilator Utilization Ratio

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Surviving the ICU: A perspective from both sides of the bed

Dr. Alison Clay

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An Ounce of Prevention: Non-pharmacologic Care for Delirium

Dr. Tammy Hshieh slides

Delirium Prevention: patient & hospital-wide benefits

NYU Winthrop Hospital Team Dr. Jeffrey Berger

Maureen Gaffney, MHS, PA-C, RN

Hospital Questions and Discussion NYSPFP StaffHospital Participants

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NYSPFP Delirium Data Entry, Tools and Resources

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NYSPFP Website: Tools and Resources

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www.nyspfp.org

www.nyspfp.org/Members/Initiatives/InfectionPrevention/VAP/Tools.aspx

Additional Resources:

• IPRO VAE Master Project Plan• PAD Assessment Tools

• Critical Care Pain Observation Tool• Behavioral Pain Scale• Richmond Agitation-Sedation Scale• Sedation Agitation Scale• Complete CAM-ICU Training Manual• Intensive Care Delirium Screening Checklist• ABCDEF Bundle Action Planning Tool

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ABCDEF Bundle Action Planning Tool

May 30, 2017 1

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VAE Prevention Strategies and Hospital Action Planning tool

https://www.nyspfp.org/Members/Initiatives/InfectionPrevention/VAP/Tools.aspx

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NYSPFP Delirium Data Entry

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NYSPFP PAD Process Measure Tracking Tool

https://www.nyspfp.org/Materials/NYSPFP-Critical-Care-Data-PADTool.xlsx

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NYSPFP Delirium Measure Data Entry

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NYSPFP Delirium Measure Data Entry

Monthly drop down

Hit save

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Critical Care Team Education & SupportTargeted education and tools for Critical Care Unit Staff:○ VAE/Delirium Prevention○ Daily Safety Checks○ Sepsis

○ HIIN Tools:○ Critical Care Gap Analysis○ Critical Care Checklist○ Critical Care Data Collection Tool

○ Project Manager Support

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Next Steps ○ Gather your Critical Care team ○ NYS Partnership for Patients VAE/Delirium In-Person full

day conference September 26, 2017 Syracuse, September 27, 2017 NYC SAVE THE DATE!

○ NYSPFP Project Managers will support you in:○ Completing/repeating the ABCDEF Bundle action plan, Non-

Pharmacological Interventions to prevent and manage Delirium gap analysis and action plan and the VAE action plan

○ Using the PAD data collection tool, if your facility does not have its own process to collect this information

○ Submitting delirium measure data monthly into the NYSPFP Data Portal