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presented by Kathleen Vollman, MSN, RN, CCNS, FCCM, FAAN
Financial: Kathleen Vollman has a financial relationship as a Consultant with Michigan Hospital Association Keystone Center; Consultant and Speaker Bureau with Sage Products now a part of Stryker; Consultant and Speaker Bureau with Eloquest Healthcare; and Subject Matter Expert on CAUTI, CLABSI, C-diff for HERT’s Hospital Improvement Initiative Network. Kathleen Vollman receives compensation from MedBridge for this course.
Non-Financial: Kathleen Vollman has no competing non-financial interests or relationships with regard to the content presented in this course.
Satisfactory completion requirements: All disciplines must complete learning assessments to be awarded credit, no minimum score required unless otherwise specified within the course.
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More than a quarter of a million patients in the United States receive mechanical ventilation each year, putting them at risk for increased mortality related to pneumonia and acute respiratory distress syndrome, among other lung injuries. How can we prevent these ventilator-associated events (VAE)? Pain/sedation/delirium management, oral care, ventilator setting, early removal of the ventilator, and progressive mobility have all been shown to have a significant impact on outcomes of patients receiving mechanical ventilation. This course will explore the evidence around implementation of the ABCDEF bundle to reduce both short- and long-term negative consequences of mechanical ventilation and the ICU. This course content is applicable to nurses and other health care professionals who work with patients in acute care, rehabilitation, and long-term care settings.
Kathleen Vollman, MSN, RN, CCNS, FCCM, FAAN
Kathleen Vollman is a Critical Care Clinical Nurse Specialist, Educator, and Consultant. She has published and lectured nationally and internationally on a variety of topics, including pulmonary care, critical care, prevention of health-care-acquired injuries, work culture, and sepsis recognition and management. From 1989 to 2003, she functioned in the role of Clinical Nurse Specialist for…
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1. Defining Ventilator-Associated Events and Their Impact
In order to establish more objective surveillance criteria, the CDC transitioned from ventilator-associated pneumonia to ventilator-associated events (VAE) in adult acute care hospitals and in long-term care hospitals. VAE surveillance detects a broader range of conditions. In this chapter, the three types of VAEs are discussed.
2. Examining the Short- and Long-Term Effects of Mechanical Ventilation and Prolonged Stay in the ICU
A large number of patients who were on mechanical ventilation in the ICU experience physical disabilities, challenges in cognitive function, and mental health issues. Twenty to eighty percent of ICU patients have delirium during their time in the ICU. This contributes to cognitive impairment as well as depression and PTSD that can persist for years. This chapter explores the long-term effects of mechanical ventilation and ICU if the correct prevention strategies are not put in place.
3. Ventilator Bundle to the VAE/VAP Bundle
The original ventilator bundle was created in the early 2000s to help prevent injury associated with being on a mechanical ventilator. In this chapter, the prevention strategies to reduce risk of aspiration, stress ulcers, and deep vein thrombosis are discussed. The next two chapters will outline the evolution of a larger bundle that improves overall care of the ICU mechanically ventilated patient.
4. ABC Part of the Bundle
The ABCDEF bundle extends the original VAP bundle and was developed to improve the health of ventilated patients by reducing the risk of oversedation and immobility, improving patient comfort, reducing the risk of infection, and decreasing the risk of mental status changes and long-term morbidity. In this chapter, we will discuss the ABC portion of the ABCDEF bundle: Assess and manage pain, Both spontaneous awakening trial and spontaneous breathing trial, and Choice of sedation.
5. DEF Part of the Bundle
The ABCDEF bundle extends the original VAP bundle. In this chapter, we will discuss the DEF portion of the ABCDEF bundle, which helps the clinician assess and manage delirium and implement an early progressive mobility program while engaging the patient and family in the journey.
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