Are we required to use the permutation table, or can we choose another method to randomly select our observation day?

All hospitals must use the same process to do the random selection. This will eliminate any bias that might occur if the selection process is not randomized. The permutation table is already in random order and all hospitals should use it. It indicates on which days HOB should be monitored for each month and does not require modification or skipping of any rows.

HAI - Ventilator-Associated Pneumonia (VAP) Prevention Manual

  1. Who can document a contraindication? Does it have to be a physician or can a nurse document the contraindication in the nursing notes?
  2. As of July 1, 2009, is participation still voluntary?
  3. Who makes the observations?
  4. Do you have to make the actual observation or can it be done by chart review?
  5. For small facilities with limited ventilator usage, do we do 100% review?
  6. Are we required to use the permutation table, or can we choose another method to randomly select our observation day?
  7. Are patients on tracheostomy tubes counted?
  8. What do you do if the patient’s bed is “down” for a valid reason during the observation (e.g., turning patient, patient is having an abdominal x-ray or a procedure that requires a supine position)?
  9. Data collection will be difficult on weekends, due to the shortage of staff. Can we adjust the permutation schedule to exclude data collection on weekends?
  10. Some of the small hospitals have very few ventilated patients. When using the permutation table, there may be several weeks when there isn’t a patient on the ventilator in the ICU on the specified day for HOB observations. Should the hospital still adhere to the day listed in the table, or, should they record their observations when they have a ventilated patient in the ICU regardless of the day of the week?
  11. We have a burn unit that has two ICU beds. Are there a certain number of ventilator days an ICU should have before they are included in the HOB elevation reporting?
  12. What are contraindications to HOB elevation to 30º or greater?

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