VAE & VAP K-Card

HAC SPS Bundle Elements

Which department are you completing this survey for?

Name of the employee observed:

Patient MRN?

Was there a daily discussion of readiness to extubate among bedside and medical care team members during rounds?

Every day the care team should actively discuss whether the patient still needs to be intubated and what steps are necessary to move towards extubation.
Was the Head of the bed elevation appropriate (confirm visual measurement on bed)?

30-45 degrees for all ventilated patients beyond infancy.
15-30 degrees for 0-30 days post 40 weeks, unless otherwise noted in small baby guidelines.
 
Was the ventilator circuit inspected every 8 hours?

Inspect for gross contamination/soiled and condensation. Avoid changing the ventilator circuit on a routine basis.
Was gross contamination/soiling and/or condensation found?
Was disruption to the ventilator circuit minimized?
Was oral hygiene performed every 4 hours?

Inpatient Rehab perform oral hygiene every 4 hours when patient awake.
Brushing teeth and gums with a soft bristle toothbrush and product for plaque removal, or use a gauze and sterile water for patients without teeth.
Consider performing oral care (moistening mouth and lips, removal of oropharyngeal secretions) before repositioning patient.
Were the appropriate suction devices changed accordingly?

Closed suction catheters and suction tubing change when visibily soiled or mechanical malfunction.
Open sucition canisters are single use only.
Open sucition tubing change QD and PRN.
Oral/Nasal suction devices change weekly and PRN.
Sucition canisters change weekly and PRN.
If any No is chosen above, please provide more details.