353

Abstract

Introduction: Adherence with accepted intensive care unit prophylaxis measures such as head of bed elevation, mouth care, stress ulcer prevention, and venous thromoboembolism prevention was inconsistently ordered. Hypothesis: Standardized order set will improve compliance with intensive care unit (ICU) standard prophylaxis measures and will lead to a reduction in ventilator associated pneumonia. Methods: Systemic review of all ICU order sets was conducted. Prophylaxis measures were removed from pre-existing order sets and bundled into a new prophylaxis order set (POS) that included measures oral care, stress ulcer prevention, and venous thromboembolism prevention. In addition, a surveillance program to identify patients with methicillin- resistant staphylococcus aureus was initiated using polymerase chain reaction (PCR) testing on all ICU patients upon admission. Prevalence data was collected by an independent observer an all patients admitted to the ICU on random days during the study period. Patients were scored to be either compliant or non-compliant with prophylaxis by an independent review panel. Baseline data was obtained for 2 months with follow up prevalence data at 2 and 4 months. Results: Baseline compliance with prophylaxis measures was 40% prior to the implementation of the POS. Compliance with prophylaxis measures post-implementation was 90% at two months and 88% at four months. One year prior to POS implementation, ventilator associated pneumonia rate was 5.4 per 1,000 ventilator days. One year after POS implementation, ventilator associated pneumonia rate was 0 per 1,000 ventilator days. Conclusions: Use of a standardized POS was associated with a two-fold increase in compliance with prophylaxis measures that was sustainable. Additionally, the POS was associated with a marked decrease in our ventilator associated pneumonia rate one year after POS implementation.