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It Takes a Village

It Takes a Village. Contra Costa Regional Medical Center Stuart Forman, MD Kathryn Moore, OTR/L Ronald Marquez, PT Angela Bennett, RN Trent Tate, RCP. Where we were. VAP Rate/ 1000 ventilator days. Where we are now. Last VAP January 2011 . How did we get there?.

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It Takes a Village

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  1. It Takes a Village Contra Costa Regional Medical Center Stuart Forman, MDKathryn Moore, OTR/L Ronald Marquez, PT Angela Bennett, RN Trent Tate, RCP

  2. Where we were VAP Rate/ 1000 ventilator days

  3. Where we are now Last VAP January 2011

  4. How did we get there?

  5. Step 1: Examine the evidence

  6. Step 2: Find a Champion

  7. Step 3: Engage a team

  8. Step 4: Small tests of change

  9. Step 5: Rapid Cycle Improvement

  10. Step 6: Build on Success

  11. ABCDE Building Blocks • Wake up and breath protocols • Ventilator bundles • CAM-ICU • Daily ventilator rounds • ICU OT/PT staffing

  12. What Were Our Barriers? • Inertia • Staffing • Skeptical doctors • Antiquated chart system • Data gathering

  13. How Did We Overcome These Barriers? • EBM • Use people’s normal work flow • Invite participation from all team members • Showcase results • Engage quality and infection control managers

  14. What Did We Learn From This Improvement Effort? • Don’t try everything at once • Culture beats strategy • Engaged leaders • Put front line workers in charge • Data collection is not easy

  15. What Can We Teach From Our Journey? • Step 1: Find the evidence of efficacy • Step 2: Find a champion • Step 3: Engage the team • Step 4: Small tests of change • Step 5: Rapid cycle improvement—don’t expect perfection • Step 6: Share and build on your successes • Step 7: Lather, rinse repeat

  16. Feel Free to Contact Us: Stuart Forman, MD, FAAFP Medical Director, Critical Care Services 2500 Alhambra Ave. Martinez, CA 94553 Stuart.forman@hsd.cccounty.us

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