Midterm (proposal development) - Research Paper Example

These elements are: (a) elevation the patient’s head of the bed between 30 and 45 degree unless medically contraindicated; (b) a daily sedation vacation and assessment of readiness to ‘extubate’ unless medically contraindicated; (c) peptic ulcer prophylaxis; (d) deep vein thrombosis prophylaxis; (e) use ‘chlorhexidine’ for oral care. The entire bundle was considered compliant only if all five items were compliant. A bundle was considered noncompliant if any item was not performed. The dependent variable for this literature review is reducing the incidence of Ventilator-Associated Pneumonia (VAP) rate among Intensive Care Unit ICU patient population.

VAP is defined by pneumonia occurring more than 48 hours after patient have been ‘intubated’ and placed on mechanical ventilation (Koeman et al., 2006). The patients must have been free from any sign of pneumonia or chest infection in radiological images prior VAP development. The ventilator-associated pneumonia (VAP) rate is defined as the number of ventilator-associated pneumonias per 1,000 ventilator days (Garcia et al., 2009). The independent variables are implementation of VAP bundle, developing oral care protocol using ‘chlorhexidine’, implementation of Nurse-implemented sedation protocol, and Staff training program on VAP bundle.

All of these independent variables are considered intervention to improve healthcare providers’ compliance with VAP bundle and consequently, reduces the incidence of VAP. Oral care is defined by cleansing of oral cavity and oropharynx using cholrhxidine every 2-4 hours per as protocol (Koeman, et al, 2006). Active implementation is defined as providing various types of educational programs (in-service presentation, video, workshop) to all healthcare providers on VAP , VAP rate, VAP related-complications, and VAP preventative measures (VAP bundle) (Hawe, Ellis, Cairns, & Longmate, 2009).

Nurse-implemented sedation protocol defines a strategy that guides a nurse in administering dosage, in this case, to ventilated patients based on their weight and level of consciousness by using Cambridge scale (Quenot et al., 2007) in order to prevent patients’ over sedation. There is abundant research showing that hospitals that implement the VAP Bundle significantly reduce the incidence of VAP. A quasi-experimental study of all adult patient who admitted to ICU and required mechanical ventilation from 2006-2008 , the sample size and sampling plan were not mentioned, revealed that VAP bundle reduces the incidence of VAP from 9.

3 cases per 1000 ventilator day to 2.3 cases per 1000 ventilator day (p = .001) using Box-and-whisker plot. Furthermore, U chart revealed that the overall compliance with VAP increased from 20 percent to 82 percent (Al-Tawfiq & Abed, 2010). A quantitative randomized, double-blind, placebo controlled trial study of 385 consecutive random sampled adult ICU patients revealed that topical oral decontamination with chlorhexidine reduces the incidence of VAP by 65 percent (p = 0.012) for chlorhexidne and 55 percent (p = 0.030) for chlorhexidine/cholistin using sequential survival analyses (Koeman et al., 2006). The qualitative study of a convenience sample of 10 registered nurses’ working in ICU, using content analysis, revealed that nurses’