• Paul Youngquist, Michelle Carroll, Michelle Farber, Deborah Macy, Pamela Madrid, Jeanine Ronning, and Amy Susag.
• Mercy & Unity Hospitals, Coon Rapids, Minnesota, USA. p_youngquist@msn.com
• Jt Comm J Qual Patient Saf. 2007 Apr 1;33(4):219-25.

BackgroundMercy & Unity Hospitals of Minnesota implemented the ventilator bundle concept as part of an Institute for Healthcare Improvement (IHI) collaborative on improving care in the intensive care unit (ICU).MethodsThe two hospitals, which function as a single hospital, have a total of 450 beds, and each has a 20-bed ICU. The IHI bundle was composed of (1) head-of-bed elevation, (2) a daily "sedation vacation" along with a readiness-to-wean assessment, (3) peptic ulcer disease prophylaxis, and (4) deep vein thrombosis prophylaxis. Additional interventions likely complementary to the ventilator bundle were a hand hygiene campaign and an oral care protocol.ResultsOverall compliance with the four bundle elements reached 100% by January 2004. At the end of the collaborative, Mercy's VAP rate decreased from 6.1 to 2.70 per 1000 ventilator days, and Unity's VAP rate decreased from 2.66 to 0 per 1000 ventilator days.DiscussionThe all-or-none nature of the bundle may have helped multidisciplinary staff members perceive the project as a systemic change versus a one-time intervention. Staff members needed to implement both structural changes, such as preprinted order sets for ventilator management and sedation, and cultural changes, such as increased collaboration with respiratory therapy.ConclusionThe decrease in VAP provides a promising example of the potential of intervention techniques and bundle implementation in a community hospital.

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