External ventricular drains (EVDs) are commonly used to facilitate removal of cerebrospinal fluid in patients with neurologic dysfunction. Despite a high risk for infection (upward of 45%), many hospitals lack strict protocols for EVD placement and maintenance. In addition, EVD infections are typically not tracked with the same diligence as central-line catheter infections, because there are no widely accepted standards for routine management of EVDs. The purpose of this review is to provide a guide for the development of a standardized, best practice EVD protocol for catheter insertion, care, and maintenance to reduce ventriculostomy-related infections. A secondary goal of this review is to provide support for the future development of guidelines for the consistent tracking of EVD insertion and maintenance practices.At an academic medical center, an interdisciplinary team of nurses, advanced practice nurses, and neurointensivists reviewed recent medical and nursing literature as well as research-based institutional protocols on EVD insertion and maintenance from the United States and abroad to determine global best practices. The goal of this literature review was to identify key areas of focus in EVD insertion and maintenance as well as to identify recent studies that have shown success in managing EVDs with low rates of infection. The following terms were used in this search: EVD, externalized ventricular drains, EVD infections, EVD insertion, EVD Care and Maintenance, Nursing and EVDS. The following databases were utilized by each member of the interdisciplinary team to establish a state of the science on EVD management: American Association of Neurosurgical Surgeons, CINAHL, Cochrane, National Guidelines Clearinghouse, and PubMed. The following common EVD themes were identified: preinsertion hair removal and skin preparation, aseptic technique, catheter selection, monitoring of EVD insertion technique using a "bundle" approach, postinsertion dressing type and frequency of dressing changes, techniques for maintenance and cerebrospinal fluid sampling, duration of catheter placement, staff education/competence, and surveillance.

More than 1600 UHC members, staff, and supplier partners gathered in Orlando, Florida, for UHC's second annual member conference, a national showcase for performance improvement ideas in health care. The meeting is distinctive for its atmosphere of high-energy collaboration and idea sharing among the nation's academic medical centers (AMCs) and their network partners.

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Background: Bedside dysphagia screening potentially identifies 60% of patients at risk for aspiration. Potential/actual stroke patients may not be identified prior to oral medications/food. Our previous dysphagia screening was challenging to use and as a result, many stroke cases were missed. Problem: Potential patients at risk for aspiration pneumonia were not being identified using a dysphagia screening. Interventions: A new dysphagia screening instrument was developed by an interdisciplinary team of nurses and speech language pathologists. Pilot reliability testing of the old tool indicated a reliability of 86%, while the new tool was found to be 95% reliable. Validity testing showed that the new dysphagia screening tool predicted patients at risk for dysphagia 96% of the time, while the old instrument predicted dysphagia only 88% of stroke patients. The new dysphagia instrument was implemented in 10/2014, and is now performed for all ED patients who have a non-contrast head CT.Current real-time auditing of core measures and reporting of compliance data is now in place with accountable parties, using concurrent chart review and real-time feedback to Nurse Managers for all missed cases Results/Conclusions: Compliance with dysphagia screening has risen from 84% in 9/2014 to 100% in 6/2015. Patients at risk for aspiration/aspiration pneumonia have been successfully identified using the new dysphagia screen and measures are implemented to prevent or treat high risk patients to improve outcomes. Most patients who developed aspiration pneumonia had been previously identified as failing the new dysphagia screen and these patients were maintained npo and placed on aspiration precautions. Mortality rates for inpatient stroke patients dropped by 73% in the 4 th quarter of 2014, fostering a #1 ranking for inpatient mortality, and top 5% in overall quality for 2014 when benchmarked with other academic medical centers participating in United Health Care (UHC) rankings. The new dysphagia screening instrument and monitoring practices has dramatically improved detection of patients at risk for dysphagia/potential aspiration, and has contributed to a significantly lower rate of inpatient stroke mortality.