Ventilator Bundle (NQF 0302)

eMeasure Name Ventilator Bundle eMeasure Id 5579D8E8-39EE-43EA-97D2-3E599CA847C8
Version number 1 eMeasure Set Id F281D323-14C1-437E-AE9E-3285512A4DB9
Available Date No information Measurement Period January 1, 20xx through December 31, 20xx
Measure Steward Institute for Healthcare Improvement
Endorsed by National Quality Forum
Description The percentage of intensive care patients on mechanical ventilation for whom all five elements of the ventilator "bundle" are implemented and documented
Copyright
Measure scoring Proportion
Measure type Process
Stratification
None
Risk Adjustment
None
Data Aggregation
Rationale
Ventilator associated pneumonia (VAP) is the leading cause of death amongst hospital-acquired infections, exceeding the rate of death due to central line infections, severe sepsis, and respiratory tract infections din the non-intubated patient. Perhaps the most concerning aspect of VAP is the high associated mortality. Hospital mortality of ventilated patients who develop VAP is 46 percent compared to 32 percent for ventilated patients who do not develop VAP.

In addition, VAP prolongs the time spent on the ventilator, length of ICU stay, and length of hospital stay after discharge from the ICU. Strikingly, VAP adds an estimated cost of $40,000 to a typical hospital admission.
Clinical Recommendation Statement
Reducing mortality due to ventilator-associated pneumonia requires an organized process that guarantees early recognition of pneumonia and consistent application of the best evidence-based practices.
Improvement notation
No information
Measurement duration
12 month(s)
Reference
Ibrahim EH, Tracy L, Hill C, et al. The occurrence of ventilator-associated pneumonia in a community hospital: Risk factors and clinical outcomes. Chest. 2001 Aug;120(2):555-561.
Reference
Rello J, Ollendorf DA, Oster G, et al. VAP Outcomes Scientific Advisory Group.  Epidemiology and outcomes of ventilator-associated pneumonia in a large US database. Chest. 2002 Dec;122(6):2115-2121.
Reference
Tablan OC, Anderson LJ, Besser R, et al. CDC Healthcare Infection Control Practices Advisory Committee. Guidelines for preventing health care-associated pneumonia, 2003: Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep. 2004 Mar 26;53(RR-3):1-36.
Definition
Initial Patient Population(s): All patients on ventilators in ICU >= 18 years of age at the date of ICU admission
Definition
Denominator(s): Total number of intensive care unit patients on mechanical ventilation
Definition
Denominator Exclusion(s): Patients less than 18 years of age at the date of ICU admission . Since only patients >= 18 years of age are included, no additional logic is required.
Definition
Numerator(s): Number of ICU patients on mechanical ventilation at the time of survey for whom all five elements of the ventilator bundle are in place: 
	Head of bed (HOB) elevation 30 degrees or greater (unless medically contraindicated); noted on 2 different shifts within a 24 hour period;
	Daily "sedation interruption" and daily assessment of readiness to extubate; process includes interrupting sedation until patient follow commands and Patient is assessed for readiness to extubate. Discontinuation of mechanical ventilation; Parameters of discontinuation include: resolution of reason for intubation; inspired oxygen content roughly 40%; assessment of patients ability to defend airway after extubation due to heavy sedation; minute ventilation less than equal to 15 liters/minute; and respiratory rate/tidal volume less than or equal to 105/min/L(RR/TV< 105)
DVT (deep venous thrombosis) prophylaxis 
SUD (peptic ulcer disease) prophylaxis  
Oral care
Definition
Denominator Exception(s): Patients for whom bundle elements are contraindicated.
Guidance
This is an "all or nothing" measure. If any of the elements are not documented for each day that the patient is ventilated, do not count the patient in the numerator. If a bundle element is contraindicated for a particular patient and this is documented appropriately in the medical record, then the bundle can still be considered compliant with regard to that element.
Supplemental Data Elements
Report "Patient Characteristic: Gender" using "Gender HL7 Value Set (2.16.840.1.113883.1.11.1)"; Report "Patient Characteristic: Race" using "Race CDC Value Set (2.16.840.1.114222.4.11.836)"; Report "Patient Characteristic: Ethnicity" using "Ethnicity CDC Value Set (2.16.840.1.114222.4.11.837)"; Report "Patient Characteristic: Payer" using "Payer Source of Payment Typology Value Set (2.16.840.1.113883.3.221.5)".

Table of Contents


Population criteria

Data criteria (QDM Data Elements)

Supplemental Data Elements




Measure set CLINICAL QUALITY MEASURE SET 2011-2012