Virginia Hospital Celebrates Five Years With No VAP Events

"We really had no guidelines on what oral care meant," said McCoy. "We used to do oral care whenever the staff felt like the patient needed oral care." Staff members were also using saline down the endotracheal tube, she said. The staff changed its policy so that saline was used only rarely and put an oral care procedure in place to define what was expected of staff members.

To ensure compliance with the VAP bundle, a member of the quality improvement staff audits ICU staff members' practices. Staff members are held accountable if they are aware of their responsibilities but fail to perform them, said McCoy. Charge nurses in the ICU participate in peer coaching with other nurses on the unit to help them improve compliance. McCoy also posts the compliance rates with the bundle indicators so that staff members have an idea of how they are performing.

Additionally, the ICU implemented daily interdisciplinary patient rounds. When they first began, the rounds consisted of a nurse and respiratory therapist. Now, the three- to five-minute rounds consist of those staff members plus a physician, a nutritionist, a pharmacist, a case manager, infection control specialists, and a palliative care nurse.

"This is probably one of the best things that our team agreed to try," said McCoy. "It took showing the staff what interdisciplinary rounds could do for the patient—that [the rounds were] truly helping the patient get well, rather than just busywork for them."