100000 Lives Template


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  • This trial showed that the semi-recumbent position had a substantially lower rate of VAP in both suspected and confirmed cases of VAP. Suspected cases decreased by 26%. Confirmed cases were decreased by 18% in the semi-recumbent position.
  • Kress was able to show that daily awakenings, irrespective of whether the clinician thought that the patient was ready to be awakened, decreased the number of ventilator days sharply.
  • In order to be successful, set aims and easily measurable goals. Use a method to drive change forward to meet that those goals.
  • 100000 Lives Template

    1. 1. and Related Institutions Children's Hospitals National Association of N A C H R I IHI Campaign to Save 100,000 Lives Pediatric Node presents: Preventing Ventilator Associated Pneumonia July 20, 2005 2:00 PM - 3:30 PM (ET) 1:00 PM - 2:30 PM (CT) 12:00 PM - 1:30 PM (MT) 11:00 AM - 12:30PM (PT)
    2. 2. Pre-Game Housekeeping  Phone lines have been muted to reduce background noise  *7 to unmute  *6 to mute  Please do not put your phone on “hold”  30 minutes for Q & A at the conclusion of the presentations  Session is being recorded and will be available on CHCA, NACHRI, NICHQ and IHI websites
    3. 3. and Related Institutions Children's Hospitals National Association of N A C H R I IHI Campaign to Save 100,000 Lives Pediatric Node presents: Preventing Ventilator Associated Pneumonia Moderator: Paul Kurtin, MD Vice President, Clinical Innovation Director, Center for Child Health Outcomes Children’s Hospital and Health Center, San Diego Research Professor Director of Maternal and Child Health Program San Diego State University
    4. 4. “Pediatric Node” Leadership Team  CHCA: David Bertoch, Jeff Brandon • jeff.brandon@chca.com • david.bertoch@chca.com  NACHRI: Ellen Schwalenstocker • eschwalenstocker@nachri.org  NICHQ: Connie Crowley Ganser, RN, Emily Crites, and Paul Kurtin, MD • ccganser@nichq.org • ecrites@nichq.org • pkurtin@chsd.org
    5. 5. IHI Campaign to Save 100K Lives Launched: December 2004 Pediatric Node Launched: January 2005 5 Initiatives Relevant to Pediatrics: – Prevention of Adverse Drug Events using Reconciliation of Medications (6/15/05) • 82 hospitals; 354 individuals participated in webcast – Deployment of Rapid Response Teams (6/22/05) • 86 hospitals; 345 individuals participated in webcast – Prevention of Ventilator-Associated Pneumonia (7/20/05) – Prevention of Central Line Infections (7/27/05) – Prevention of Surgical Site Infections (8/17/05) • Note time change (12:00N-1:30PM ET) this session only
    6. 6. IHI Campaign Objectives  Save 100K lives through the introduction of six proven health care improvement interventions over 18 months. (end date 6/14/06 at 9AM).  Enroll a minimum of 1600 hospitals to join IHI in this work. (To date, over 2500 hospitals have signed on to the Campaign).
    7. 7. Key Campaign Principles  Some is not a number; soon is not a time.  Get the “hard count.”  Welcome anyone at any level.  We do this together.
    8. 8. IHI Campaign Pediatric Node  Commitment of 3 major pediatric leadership organizations to convene learning collaboratives (Summer Series webcasts) featuring experts in the field.  First ever learning initiative involving the whole pediatric community (FREE).  CHCA, NACHRI, and NICHQ applaud the experts and their respective organizations for their willingness to share their expertise with the whole pediatric community.  CHCA, NACHRI and NICHQ applaud the whole pediatric community for their commitment and hard work in creating high quality healthcare for children.
    9. 9. Additional Resources  www.chca.com  www.childrenshospitals.net  www.nichq.org  www.ihi.org  For information on Campaign data submission, go to www.ihi.org.
    10. 10. VAP Faculty  Vanderbilt Children’s Hospital: – Jay Deshpande, MD Professor of Anesthesiology  Children’s Hospital, Boston: – Martha A. Q. Curley, PhD, RN Director Critical Care and Cardiovascular Nursing Research
    11. 11. and Related Institutions Children's Hospitals National Association of N A C H R I Reducing Morbidity and Mortality from Ventilator Associated Pneumonia
    12. 12. [Please note that all data presented are for Peer Review/Quality Improvement only.]
    13. 13. Impact of Ventilator- Associated Pneumonia (VAP)  15% of all hospital acquired infections  2nd most common nosocomial infection  20-33% attributable mortality rates  Increased ICU stay 4.3- 6.1 days  Excess costs of approximately $40,000/patient (Centers for Disease Control, 2003)
    14. 14.  Ventilator-associated pneumonia (VAP) is a common complication in the ICU.  Incidence of VAP ranges from 9% to 70%.  Mortality ranges from 13% to 55%.  VAP increases average hospital stay from 6 days to more than 30 days.  VAP increases cost up to $50,000 per hospital stay Rumbak, M. J. (2000). Strategies for prevention and treatment. Journal of Respiratory Disease, 21 (5), p. 321. Impact of Ventilator-Associated Pneumonia (VAP) - continued
    15. 15. Changing Views on VAP  No longer just an “unfortunate” occurrence  Viewed as medical error – Institute of Medicine – Leapfrog Group  JCAHO – hospitals will be required to show VAP prevention/reduction measures
    16. 16. Ventilator Associated Pneumonia  Nosocomial Pneumonia – Hospital acquired  Diagnosis is imprecise.  Combination of: – Clinical factors - fever; change in secretions amount and quality; cough; apnea/bradycardia; tachypnea – Microbiological factors – blood, sputum, tracheal aspirate and/or pleural fluids – Radiographic factors - new or increased infiltrates
    17. 17. Bacterial causes – “Bad bugs - 1”  Early–Onset Pneumonia – Pathogens: • Streptococcus pneumoniae • Haemophilus influenzae • Staphylococcus aureus  Community-acquired  Antibiotic-sensitive
    18. 18.  Late-Onset Pneumonia  Pathogens: – Pseudomonas aeruginosa – Methicillin resistant Staphylococcus aureus – Acinetobacter – Enterobacter  Other hospital-acquired  Antibiotic-resistance increasing Bacterial causes – “Bad bugs - 2”
    19. 19. Risk Factors for Nosocomial Pneumonia  Number 1 risk factor = endotracheal intubation and mechanical ventilation!  Factors that enhance colonization of the oropharynx &/or stomach: – Administration of antibiotics – Admission to ICU – Underlying chronic lung disease  Conditions favoring aspiration into the respiratory tract or reflux from GI tract: – Supine position *GERD – NGT placement *Comatose – Intubation and self-extubation – Immobilization – Surgery of head/neck/thorax/upper abdomen
    20. 20. Risk Factors for Nosocomial Pneumonia (continued)  Conditions requiring prolonged use of mechanical ventilatory support – And potential exposure to contaminated respiratory devices &/or contact with contaminated hands.  Host Factors: – Extremes of age – Malnutrition – Immunosuppression – Underlying condition/disease process
    21. 21. Implications of VAP  Increased LOS  Increased ventilator days  Increased risk of infection  Increased costs  Increased morbidity and mortality
    22. 22. The Ventilator Bundle ….is a package of evidence-based interventions that, when implemented together for all patients on mechanical ventilation, results in dramatic reduction in the incidence of ventilator-associated pneumonia.
    23. 23. The Ventilator Bundle  The power of a “bundle” is that it brings together evidence-based practices that individually improve care, but when applied together result in substantially greater improvement.  The science behind the bundle is so well established that it should be considered a “standard of care”.  The focus of measurement is then completion of the entire bundle as a single intervention, rather than completion of its individual components.
    24. 24. Adult “Ventilator Bundle” 1. Elevation of the head of the bed to between 30 and 45 degrees 2. Daily “Sedation Vacation” and daily assessment of readiness to extubate 3. Peptic ulcer disease prophylaxis 4. Deep vein thrombosis (DVT) prophylaxis
    25. 25. Adult “Ventilator Bundle”  Preventing VAP – Elevation of the head of bed to 30 and 45 degrees • Reduction in the risk of aspiration of gastric contents and improved ventilation – Daily “sedation vacation” & daily extubation readiness testing (ERT) • Reduce the duration of mechanical ventilation and the risk of VAP  Preventing other complications associated with mechanical ventilation – Peptic ulcer disease prophylaxis – Deep vein thrombosis prophylaxis
    26. 26. Head of the Bed 30-45o Randomized controlled trial: 86 adult intubated patients on mechanical ventilation assigned to semi-recumbent (45o ) or supine position Semi-recumbent: Supine: Suspected VAP: 8% 34% (CI for difference 10-42%: p=0.003) Confirmed VAP: 5% 23% (CI for difference 4-32%: p=0.018) Drakulovic MB. Lancet.1999;354:1851-1858.
    27. 27. Sedation Vacation 128 adults on mechanical ventilation randomized to daily interruption of sedation until the patient was awake.  Duration of ventilation: 4.9 days vs. 7.3 days (p=0.004) Kress JP. N Engl J Med. 2000; 342: 1471-1477.
    28. 28. PEDIATRIC CRITICAL CARE MEASURES (NACHRI/CHCA/MMP)  Ventilator-associated pneumonia not included in initial core measure set – difficulty of differentiating ventilator-associated from community-acquired pneumonia in children – lack of evidence in the pediatric population with regard to effective practices for preventing infection
    29. 29. Given the lack of evidence … Are kids different?  Same – Aspiration of oropharyngeal or gastric secretions contaminated with potentially pathogenic organisms around the endotracheal tube. – Colonization of the ETT with bacteria encased in biofilm may result in embolization into the alveoli during suctioning.  Different (aside from the obvious) – Development - Dentation – Use of uncuffed tubes – Use of saline during ETT suctioning – Open suctioning
    30. 30. Adult Pediatric “Ventilator Bundle” 1. Elevation of the head of the bed to between 30 and 45 degrees 2. Daily “Sedation Vacation” and daily assessment of readiness to extubate 3. Peptic ulcer disease prophylaxis 4. Deep vein thrombosis (DVT) prophylaxis
    31. 31. Given the Lack of Evidence … What Should a Pediatric Ventilator Bundle Include?  Standard of Care  Best practices – Should implement low-risk practices – Should collect data to support the implementation of potentially high-risk practices (Do no harm)
    32. 32. AJRCC 2005;71:388-416 http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5303a1.htm Guidelines for Preventing Health-Care--Associated Pneumonia, 2003 Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee
    33. 33. Modifiable Risk Factors General prophylaxis (Standard of Care) Effective infection control measures – Staff education – Compliance with hand disinfection – Isolation to reduce cross-infection with multidrug- resistant (MDR) pathogens Surveillance of ICU infections – Identify and quantify endemic and new MDR pathogens – Guide appropriate antimicrobial therapy
    34. 34. Modifiable Risk factors Intubation and mechanical ventilation Avoid intubation and reintubation – Use noninvasive ventilation whenever possible Use orotracheal/orogastric tubes to prevent nosocomial sinusitis (direct causality not proven) If cuffed ETTs, inflate them to maintain cuff pressure no greater than 20 cm H2O
    35. 35. Modifiable Risk factors Intubation and mechanical ventilation Avoid neuromuscular blockade Prevent ventilator circuits condensate from entering ETT or in-line medication nebulizers …. Use closed ETT suctioning and eliminate saline instillation.
    36. 36. Use of Saline During ETT Suctioning CHB MSICU Practice Guideline
    37. 37. Modifiable Risk factors Intubation and mechanical ventilation Use protocols to improve the use of sedation and to accelerate weaning Avoid constant heavy sedation Minimal yet effective sedation Sedation scoring every 4 hours Goal directed therapy  Sedation vacation  Use extubation readiness test Assure adequate nurse staffing and use nurse- implemented protocols to improve infection control practices and reduce duration of mechanical ventilation.
    38. 38. Chemically Paralyzed OR Developmentally Dysmature Score Definition Ventilation Unresponsive No autonomic response to noxious stimuli -3 Unresponsive No spontaneous respiratory effort -2 Responsive only to noxious stimuli Spontaneous but ineffective respiratory effort Responsive < 20% increase in HR & BP to a noxious stimulus -1 Responsive to touch or name Spontaneous & Effective Vt0 Calm & cooperative +1 Restless but cooperative Hyper-responsive ≥ 20% increase in HR & BP to a noxious stimulus +2 Agitated Difficulty synchronizing with ventilator +3 Dangerously agitated, uncooperative Unsynchronized with ventilator Modified Motor Activity Assessment Scale Score as patient’s response to Voice  Touch  Noxious Stimuli: (suctioning or nail bed pressure) From Curley et al. (2001). Critical Care Nursing of Infants and Children
    39. 39. Adapted from Randolph et al. (2002) JAMA, 288: 2561
    40. 40. Modifiable Risk factors Aspiration, body position, and enteral feeding Position HOB up 30–45° to prevent aspiration, especially when receiving enteral feeding  Continuous rotational therapy and prone positioning Use enteral nutrition to decrease risk of bacterial translocation Use post-pyloric feeding in high risk patients (depressed gag reflex, delayed gastric emptying, gastro-esophageal reflux and severe bronchospasm)
    41. 41. Modifiable Risk factors Modulation of colonization: oral antiseptics and antibiotics  Consider prophylactic systemic antibiotics for 24 hours post emergent intubation (closed head injury)  Modulate oropharyngeal colonization with oral chlorhexidine (need more data) Mouthcare and oral/nasal suction practice guideline (follow ADA guidelines; “gentle” oral/nasal suction with supplies that are changed daily) Anne Bisch, RN, MSN; St Louis U; ACB3886@bjc.org Cindy Munro, RN, PhD; R01NR007652, Oral care intervention in mechanically ventilated adults Mavilde Pedreira, RN, PhD; Federal University of São Paulo
    42. 42. Comprehensive Oral Care Program  The Good Shepherd – Retrospective study – VAP rate after practice change showed decrease of 3.4 per 1000 ventilator days – Cost savings approximately $30,000 per VAP Schleder, B., Stott, K., & Lloyd, R.C. (2002). The effect of a comprehensive oral care protocol on patients at risk for ventilator-associated pneumonias. Journal of Advocate Health Care, 3(1), 1-8.
    43. 43. Modifiable Risk factors Stress bleeding prophylaxis If needed, stress bleeding prophylaxis with either H2 antagonists or sucralfate (Reduced VAP with sucralfate but slightly higher rate of clinically significant gastric bleeding)
    44. 44. Give your patient a fast hug (at least) once a day* Jean-Louis Vincent, MD, PhD, FCCM  Fast Hug mnemonic (Feeding, Analgesia, Sedation, Thromboembolic prophylaxis, Head-of-bed elevation, stress Ulcer prevention, and Glucose control)  Identify and check key aspects in the general care of all critically ill patients.  Feeding (bowel regimen) & Family  Analgesia  Sedation  Thromboembolic prophylaxis, Tubes & Test (extubation readiness)  Head-of-bed elevation & Honeymoon paralytics  Ulcer prevention (peptic and skin)  Glucose control, GI Prophylaxis and Get OOB Crit Care Med 2005; 33:1225–1229
    45. 45.  ZAP-VAP initiative at Vanderbilt Together we can make a difference!
    46. 46. ZAP VAP Team at Children’s Hospital  Ann Johnson - CNS  Chris Lynn – RT  Trish Campbell - RN  Tracy Hann – I.C.  Jill Kinch - PCCNP  Rick Barr - MD  Sandra Dennis  Cheryl Burney-Jones  Lisa Chumley  Shawn Austin  Liz Taketani  Stormie Eldred  J. K. Deshpande – MD  Pat Throop – Qual Consultant  Our thanks to the Surgical Intensive Care Team (J. Morris, MD – Chair)  Missy Travis – RN, CIC  Tom Talbot – MD, IC  Addison May – MD  Devin Carr – RN
    47. 47. Prevention Practices  Basic infection control measures  Bundle of treatments to improve patient outcomes  Started on admission  Maintained by RNs, RTs, NPs, and MDs by daily care practices  Considered as Standards of Care for intubated patients
    48. 48. Ways we will ZAP VAP! Numero Uno-  Wash Hands!  Wash Hands!  Wash Hands!
    49. 49. Perform Hand Hygiene  Upon reporting for work  Before gloving  After glove removal  Before and after each patient contact or contact with the patient environment (e.g. bed, table)  After handling contaminated objects  Before handling medications  Before eating  After using the restroom  When leaving the facility
    50. 50. ZAP VAP Decreasing the risk of aspiration is key in preventing VAPs.  Elevate HOB > 30 degrees (unless contraindicated)  Monitor gastric residuals q 4 hrs
    51. 51. ZAP VAP  Aggressive oral care with documentation every 2 hours with Sage Q-Care Oral Cleansing and Suctioning system.  Special pieces include: – A covered Yankauer – A Y-connector to establish a dedicated oral care line – A suction toothbrush – A suction oral swab – Perox-a-mint mouthwash – Mouth moisturizer  A new suction canister and kit will be obtained q 24 hrs
    52. 52. ZAP VAP  Hypopharyngeal suctioning will be performed before suctioning the ETT, before repositioning the ETT, before deflating the cuff, and before repositioning your patient to prevent aspiration of pooled secretions.
    53. 53. ZAP VAP  Equipment care for patient care: – Use Ballard system or use 2 people (per policy) – Keep saline jet, end of vent circuit, Simms adapter, and patient’s bag off the bed. Hang them up or place them on a sterile paper (from gloves or gauze). – Help keep the vent circuit free from accumulated water by draining water away from the patient. – Change the suction canister and mouth care kit every 24 hours. CATHETERS-TUBING-CIRCUITS-KITS-CANNISTERS-BALLARDS-ADAPTERS-JETS
    54. 54. ZAP VAP STARTS WITH YOU!  Be PROACTIVE  Be your patient’s ADVOCATE  Be a REMINDER to others  Be a POSITIVE INFLUENCE on our outcomes  Be VIGILENT in your care
    55. 55. ZAP VAP initiative at Vanderbilt SO WHAT?
    56. 56. Vanderbilt Children's Hospital Days Between Episodes of Ventilator Associated Pneumonia: PCCU January 2004 through June 2005 0 10 20 30 40 50 60 70 80 90 100 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 VAP Episode Days "Zap Vap" Initiative implemented Higher = better [Please note that all data presented are for Peer Review/Quality Improvement only.]
    57. 57. Vanderbilt Children's Hospital Ventilator Associated Pneumonia Rate : PCCU April 2004 through June 2005 0 5 10 15 20 25 Apr-04 M ay-04 Jun-04 Jul-04 Aug-04 Sep-04 O ct-04 Nov-04 Dec-04 Jan-05 Feb-05 M ar-05 Apr-05 M ay-05 Jun-05 %per1000devicedays Lower = better "Zap Vap" Initiative implemented NNIS Benchmark = 2.8% [Please note that all data presented are for Peer Review/Quality Improvement only.]
    58. 58. The Game Begins  Nightingale metrics  Spring 04  Motivation: Link process measures to outcome measures
    59. 59. 62% 78% 88% 82% 100% 0% 20% 40% 60% 80% 100% 3 month Baseline Aug '04 Nov '04 Feb '05 May '05 47 18 17 17 16 MMAAS Scoring Q4HPercentoftotal Benchmark: 100% [Please note that all data presented are for Peer Review/Quality Improvement only.]
    60. 60. 62% 78% 88% 82% 100% 0% 20% 40% 60% 80% 100% 3 month Baseline Aug '04 Nov '04 Feb '05 May '05 47 18 17 17 16 MMAAS Scoring Q4HPercentoftotal Benchmark: 100% [Please note that all data presented are for Peer Review/Quality Improvement only.]
    61. 61. Mouth Care 69% 65% 50% 94% 0% 20% 40% 60% 80% 100% Aug '04 N=13 Nov '04 N=17 Feb '05 N=16 May '05 N=16 Percentoftotal Benchmark: 100% Question read “Mouth care once in 24hrs” in August ’04 “Mouth care twice in 24hrs” in November ‘04 [Please note that all data presented are for Peer Review/Quality Improvement only.]
    62. 62. If Ventilated, Head of Bed Elevated 94% 100% 60% 90% 82% 0% 20% 40% 60% 80% 100% 3 month Baseline N=18 August '04 N=8 Nov '04 N=5* Feb '05 N=10 May '05 N=11 Percentoftotal * Incline of bed measured in Nov’ 04, Feb’05, May ‘05 See VAP practice alert at AACN.org [Please note that all data presented are for Peer Review/Quality Improvement only.]
    63. 63. Extubation Readiness Test Discussed on Rounds* 3 month Baseline 04 N=10 August 04 N=5 Nov 04 N=5 Feb 05 N=4 May ’05 N=0 Trached patients 6 1 4 2 0 ERT discussed in rounds 4/4 4/4 1/1 1/2 0 *Intubated & ventilated (not trached); OI < 6; spontaneous breathing; vent settings decreased over the past 12 hours [Please note that all data presented are for Peer Review/Quality Improvement only.]
    64. 64. To Be Successful Set an aim “Improve the health and well-being of ventilated patients by reducing the VAP rate.” Set goals: “Reduce VAP rate by 50% by April 2006.” “Implement use of ventilator bundle with greater than 95% reliability.” Plan well: Adopt a change methodology that accelerates improvement such as The Model for Improvement. Benchmark: Virtual PICU
    65. 65. ZAP VAP Thank you all for listening and participating in the discussion, Martha Curley and Jay Deshpande. Contact Information Martha A.Q. Curley, RN, PhD Martha.Curley@Childrens.Harvard.edu Jay Deshpande, MD jay.deshpande@Vanderbilt.Edu Paul Kurtin, MD pkurtin@chsd.org
    66. 66. and Related Institutions Children's Hospitals National Association of N A C H R I QUESTIONS AND DISCUSSION
    67. 67. Speaker Bios: Martha A.Q. Curley, RN, PhD, FAAN Martha A.Q. Curley, RN, PhD, FAAN is Director of Critical Care and Cardiovascular Nursing Research and serves on the faculty of the Program for Patient Safety and Quality at Children’s Hospital, Boston. She holds several academic appointments, including Assistant Clinical Professor of Anesthesia at Harvard Medical School. Dr. Curley serves on numerous hospital, regional and national committees. She is chair of the Nursing Research Council at Children’s Hospital and a member of the Research Steering Committee of the Institute for Nursing Healthcare Leadership. Among her many national committee assignments, she has served as a member of the Committee on Clinical Guidelines and Levels of Care for PICU of the Society of Critical Care Medicine. At the international level, she co-chaired the Scientific Committee for the 4th World Congress of the World Federation of Pediatric Intensive and Critical Care Societies. As a member of the American Association of Critical Care Nurses (AACN) Certification Board of Directors, she contributed to the development of acute care nurse practitioner standards of care and the agreement to co-sponsor a joint certification for acute care nurse practitioners by AACN and the ANA – the first of its kind in the history of nursing. Dr. Curley has made substantive contributions in research, teaching and clinical care. Her pioneering studies on the Nursing Mutual Participation Model of Care serve as a foundation for the contemporary role of parents as partners in the care of critically ill children. She developed and published a phase one safety and efficacy study on early and repeated prone positioning in pediatric patients with acute lung injury and is the principal investigator of a large federally funded randomized control trial on prone positioning. Dr. Curley received the American Journal of Nursing Critical Care Book of the Year Award in 1997 and 2002 and was invited to contribute the lead article in Volume 1 of the Journal of the Society of Pediatric Nurses and to serve as guest editor of Volume 1 of Excellence in Nursing Knowledge. She was the primary architect of the Synergy Model, which serves as the blueprint for the CCRN and CCNS certification as well as a framework for nursing care delivery in pediatric and adult hospitals across the country. Dr. Curley was awarded lifetime membership in the American Association of Critical Care Nurses, the Norma J. Shoemaker Award for excellence in critical care nursing from the Society of Critical Care Medicine and the distinguished alumna award from Yale University. She was inducted into the American Academy of Nursing in 1998.
    68. 68. Speaker Bios: Jay K. Deshpande, MD, MPH Jay Deshpande, MD, MPH is Director of the Division of Pediatric Critical Care Medicine and Medical Director of Performance Management and Improvement at Vanderbilt Children’s Hospital. He is Professor of Pediatrics and Anesthesiology and serves as Vice Chair for Clinical Affairs in the Department of Pediatrics and Vice Chair for Faculty Affairs in the Department of Anesthesiology at Vanderbilt University Medical Center (VUMC). Dr. Deshpande is engaged in numerous professional activities, most recently as the Vice President/President Elect of the Society for Pediatric Anesthesia and Chairman of the Education Committee for the Society. He serves on several hospital committees, including the VUMC Executive Safety Committee and the VUMC Executive Quality Council. He is a member of the Board of Directors of The Vanderbilt Medical Group. Dr. Deshpande has served as a mentor to numerous fellows, interns and graduate students. He has authored multiple journal articles and book chapters and is editor of The Pediatric Pain Handbook (1996, 2004 with J.D. Tobias). Dr. Deshpande currently is Principal Investigator under a Tennessee Emergency Medical Services for Children State Partnership Grant and a Collaborating Investigator on an AHRQ sponsored study on testing improvement strategies in critical care. Dr. Deshpande earned his medical degree from the University of Tennessee, completed his residency training in pediatrics at LeBonhuer Children’s Medical Center and in anesthesia at the Hospital of the University of Pennsylvania. He completed a fellowship in pediatric anesthesia and critical care at the Children’s Hospital of Philadelphia and was a research fellow in the Department of Anesthesia at the University of Pennsylvania and Laboratory for Experimental Brain Research at the University of Lund, Sweden. He completed a Masters of Public Health, with a focus on quality improvement at Vanderbilt Medical Center. Dr. Deshpande is certified by the Subspecialty Board in Critical Care Medicine.
    69. 69. Speaker Bios: Paul Kurtin, MD Paul Kurtin, MD is widely recognized for his work in quality measurement and improvement. In his roles as Vice President for Clinical Innovation and Director of the Center for Child Health Outcomes at Children’s Hospital and Health Center, Dr. Kurtin led the establishment of a culture focused on quality of care and evidence-based medicine. His work was instrumental in the recognition of Children’s Hospital and Health Center eoyj the JCAHO Ernest Codman award in 2002. Dr. Kurtin is a pioneer in the area of child health care improvement. He was involved in the formation of the Child Health Accountability Initiative (CHAI) and served as its medical director for five years. He is a member of the Executive Committee of the National Advisory Board of the Child and Adolescent Health Measurement Initiative and leads the strategic advisory committee for NICHQ. A nationally recognized leader in measure development and its use to improve care, Dr. Kurtin has authored numerous articles and publications on quality and outcomes and has served as an expert panelist or consultant to several organizations, including the Institute of Medicine, American Academy of Pediatrics and RAND Corporation. He was a participant in an invitational National Quality Forum Workshop on Children’s Healthcare Quality Measurement and Reporting. Dr. Kurtin has led numerous community-wide initiatives to assess the needs and improve the health of children in San Diego. He is a member of the San Diego Center for Patient Safety and was named its “Member of the Year” in 2003. Dr. Kurtin is Research Professor and Director of the Maternal and Child Health Program in the Graduate School of Public Health at San Diego State University. He received his medical degree from the New York University School of Medicine and is board certified in internal medicine and nephrology. He is a fellow of the American College of Pediatrics.
    70. 70.  CHCA: www.chca.com • jeff.brandon@chca.com • david.bertoch@chca.com  NACHRI: www.childrenshospitals.net • eschwalenstocker@nachri.org  NICHQ: www.nichq.org • ccganser@nichq.org • ecrites@nichq.org • pkurtin@chsd.org Past Broadcasts Materials from past Web casts (Medication Reconciliation, Rapid Response Teams) are available. Materials from today’s session will be available soon.
    71. 71. Future Broadcasts  July 27: Central Line Infection – (2:00 pm ET, 1:00 pm CT, 12:00 pm MT, 11:00 am PT)  August 17: Surgical Site Infection – (12:00 pm ET, 11:00 am CT, 10:00 am MT, 9:00 am PT) To register: e-mail webcasts@chca.com
    72. 72. Other Resources Available “Things that Work: Hot Topics in Pediatric Patient Safety” – American Academy of Pediatrics conference call series – www.aap.org/visit/thingsthatworkcall.htm