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977 Optimizing Management of Ventilator-associated Pneumonia using the 2005 IDSA/ATS Management Guideline

Sunday, March 21, 2010
Grand Hall (Hyatt Regency Atlanta)
Nasia Safdar, MD , University of Wisconsin Madison, Madison, WI
Joshua Medow, MD , University of Wisconsin Madison, Madison, WI
Keerthika Chinthapalli , University of Wisconsin Madison, Madison, WI
Kenneth Wood, MD , University of Wisconsin Madison, Madison, WI
Matthew Hall, MD , Marshfield Clinic, Marshfield, WI
Ann Hundt , University of Wisconsin Madison, Madison, WI
Pascale Carayon , University of Wisconsin Madison, Madison, WI
Background: Accurate diagnosis and appropriate, adequate treatment of ventilator-associated pneumonia (VAP) is essential to improve outcomes. Recent evidence-based guidelines from the Infectious Diseases Society of America/ American Thoracic Society (IDSA/ATS) provide recommendations for diagnosis and treatment of VAP. However, the guideline is not widely used by healthcare workers

Objective: To determine barriers and facilitators of guideline use for management of VAP in the ICU using the Systems Engineering Initiative for Patient Safety (SEIPS) model.

Methods: Using a sample size of 24 healthcare workers, we undertook four focus groups, two comprised of physicians and two comprising pharmacists, respiratory therapy and nursing at an academic center and a large multispecialty private practice group. The groups were asked to review the 2005 IDSA/ATS VAP management guideline and ascertain barriers and facilitators to its use. Each group was interviewed for 60-90 minutes. Interviews were recorded and transcribed. N-vivo software was used for analysis.

Results: The responses were categorized according to the model above into organizational, environmental, task related, tools and technologies and person-related. The major barriers identified in the focus groups included the lack of: consistent multidisciplinary approach to management of VAP, quantitative sampling for diagnosis,  and ready access to guidelines. Variability by type of physician provider in the ICU and lack of pharmacy and infectious diseases participation in rounds were also frequently mentioned. Facilitators included: adaptation of the guideline for local use, physician champion, ready availability of respiratory therapy to undertake mini-bronchoalveolar lavage, and active pharmacy participation to provide real time recommendations. The findings were similar for the academic and private practice group.

Conclusions: Implementation of evidence-based guidelines for management of VAP is hindered by a number of barriers that must be addressed. The findings of our qualitative assessment suggest that development of an intervention centered around a multidisciplinary team approach led by pharmacy and respiratory therapy may be a promising strategy to improve guideline adherence for management of VAP.