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Use of Goal Sheets Reduces the Incidence of Ventilator Associated Pneumonia
Melissa F Perkal1, MaryJane Rubino2, Bobbie Welch2, Karen Rosenbeck2, Maureen Levey2, Kelly Swan2, Hilary Cain1, Richard A Martinello1
1Yale University School of Medicine, West Haven, CT;2VA CT Healthcare System, West Haven, CT

Objective: Decrease the incidence of ventilator associated pneumonia (VAP) by the implementation of evidence-based practices using daily goal sheets.
Design: Literature review identified six clinical practices shown to decrease the risk of VAP: prophylaxis to prevent venous thrombosis and peptic ulcers, elevating the head of bed to > 30°, daily sedation vacation, daily readiness to wean assessment and spontaneous breathing trial. Education sessions defining the clinical practices were held. Daily goal sheet were completed to measure compliance with each of the six practices. VAP surveillance was performed according to CDC guidelines.
Setting: SICU and MICU at a Veterans hospital.
Patients: All ventilated patients between 10/04-12/06
Main Outcome Measures: Kaplan-Meier method and log-rank test was used to compare VAP-free survival before and after the intervention. Cox proportional hazards methods was used to compare pre and post intervention VAP rates.
Results: Median compliance with goal sheet completion was 64% in the SICU and 28% in the MICU (P<.001). All 6 goal sheet elements were completed for 99% in the SICU and 39% in the MICU (p=<.001). Incidence of VAP in the SICU decreased 86%, from 14.1 to 1.9 VAP/1000 ventilator-days ( P=0.005). In the MICU, incidence of VAP decreased nearly 50% (P=0.345). Duration of ventilation was significantly less in the MICU during the post intervention phase; median 5 v. 4 days (P=.04) and remained unchanged in the SICU, median 2 days (P=0.39).
Conclusions: There was a direct relationship between compliance with goal sheet use and completion of all elements with a significant reduction in the incidence of VAP. The strategy of daily goal sheets to implement evidence based practice is effective to decrease the incidence of VAP.


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