Evidence-based Practice for Prevention of Ventilator-Associatedlator Bundle - Essay Example

Evidence-based Practice for the Prevention of Ventilator -Associated Pneumonia using Ventilator Bundle in Long Term Care. I. Introduction Thepurpose of this paper is to ensure that the standardization of best practices in the management of ventilated -associated pneumonia patients using ventilator bundle are well implemented to ensure a more efficient and high quality form of patient care. The goal is geared towards the prevention of ventilator associated-pneumonia using ventilator bundle in long term care. The title of the project is Evidence-based Practice for the Prevention of Ventilator -associated Pneumonia using Ventilator Bundle in Long Term Care. The overall goal is to prevent ventilator associated-pneumonia using ventilator bundle in the long term care. The focus area is the ventilator unit of Four Seasons Nursing Home and Rehabilitation Center that comprises 35 beds. The center has its location at Rockaway Parkway, Brooklyn, New York. This involves a premiere facility that offers unparalleled medical care to the residents. They offer a wide range of services, i.e. short-term rehabilitation, long-term care, adult day health care, and the post hospital treatment, in which case they provide for an original blend of professional and exceptionally skilled nursing care that they deliver with compassion and devotion. They serve the needs and lifestyles of the community. II. Project Objectives At the end of my practicum project, I will be able to: 1. Determine what practices are used by long term care to prevent ventilator –associated pneumonia (VAP) 2. Develop a learning module for nurses on ventilator bundle for the prevention of ventilator –associated pneumonia (VAP). 3. Review and update the existing ventilator bundle protocol for the prevention of ventilator-associated pneumonia in long term care. 4. Develop a sustainable prevention program for the prevention of ventilator-associated pneumonia (VAP) in long term care. III. Evidence-based Review of the Literature The prevalence of Pneumonia is very high in the United States and its prevalence has been cited as among the top causes of deaths in infections acquired in hospitals. Ventilator associated-pneumonia (VAP), a form of nosocomnial pneumonia occurs in patients who receive a support of mechanical ventilation longer than 48 hours. The prevalence shows 22.8% for these kinds of clients. The danger to acquiring the actual pneumonia is found to go higher by10 fold in those who are under mechanical ventilation. Morbidity and mortality, hospital length of stay, and costs have all been attributed to VAP (Augustyn, 2007). The early onset VAP is in the first 3-4 days during mechanical ventilation while the late onset occurs for a period more than that. Early onset VAP is commonly caused by antibiotic-sensitive community acquired organisms like streptococcus pneumonia, haemophilus influenza, and styphylococcus aureus. Late onset of VAP is commonly caused by antibiotic resistant nosocomnial organisms like pseudomonas aeruginosa, methicillin-resistant staphylococcus aureus, acinebacter species, and enterobacter types. (Collard, et al.). This type of nonsocomial pneumonia, VAP, is a condition that requires a sensitive approach to the safety of critically ill clients. The American Association of Critical Care Nurses (AACN) has designed some measures critical to handling these conditions. They are designed according to specific formats of best practices for those getting mechanical ventilation. These steps are considered feasible, safe, and cost effective for preventing VAP which include; 1.) Elevation of the head of the bed (HOB) to 30 to 45 degrees unless medically contraindicated. 2.) Continuous removal of subglottic secretions. 3.) Change of ventilator circuit no more often than every 48 hours 4.) Washing of hands before and after contact with each patient. 5.) Consistent oral care. 6.) DVT and stress prophylaxis (De los Reyes, et al. 2007). Ventilator-associated pneumonia (VAP) in a seriously ill patient considerably increases the risk of mortality. Many hospitals have achieved considerable reductions in VAP incidences, some of them even managed to reach zero rates by taking a wide-ranging and multidisciplinary approach to the ventilator care. Preventing the VAP of any diversity seems at first blush to be a worthy goal (Pittet, et al. 2009). However, there are some reasons that are predominantly concerned about the effect of pneumonia connected with ventilator use. It exceeds the rate of death, because of the nature of central line infections, severe and grave sepsis, and infections of the respiratory tract in the non-incubated patients. Probably, the most important aspect of VAP, which requires maximum attention, is the high mortality, associated with the disease (Safdar & Abad, 2008). Hospital mortality of the ventilated patients who were diagnosed with VAP is 46 percent compared to 32 percent for ventilated patients who do not have VAP as final diagnosis (Hawe, Ellis, Cairns and Longmate, 2009). Decreasing high rate of mortality because of ventilator-associated pneumonia needs a well- prepared process that ensure early and prompt detection of pneumonia and constant implementation of the best evidence-based practices (Hawe, Ellis, Cairns and Longmate, 2009). The prevention of VAP should not only focus on a single risk factor, rather educational programs and hospital policies that identify all risk factors and prevention strategies are likely enhance compliance with regulatory agency guidelines. More important is that they are also likely to decrease mortality and morbidity.(Kurtis, 2003). IV. Methodology In my first objective which is to determine what practices are used by long term care to prevent ventilator associated pneumonia (VAP), using the Infectious Control Unit demographic and statistical data on pneumonia cases, I have to select home residents who are mechanically ventilated to be the subjects of my study for compliance of ventilator bundle for the prevention of VAP. I have to conduct surveillance on VAP using observation checklist on the 6 elements of ventilator bundle care ( head elevation, oral care, continuous removal of subglottic secretions, change of ventilator circuit, hand washing and DVT and stress prophylaxis) for once a day for the duration of one week. I also have to collect data on the current practices on ventilator bundle care using observation checklists once a day for one week. After gathering all the data I need, I have to consolidate and analyze what care bundles are currently being used and being practiced in the ventilator unit. Then final report of my findings and appropriate recommendations for best practices on the bundle care will be submitted to the Director of Nursing for comments and final approval. In my second objective which is to develop a learning module for nurses on ventilator bundle for the prevention of ventilator-associated pneumonia (VAP), I have to collect data from the nursing staff using interviews and questionnaires on needs assessment of knowledge and skills in caring for VAP patients using care bundle. Then, I have to gather and consolidate data based on the needs assessment. After gathering all the data I need, I have to analyze and interpret what learning needs to be design for the implementation of ventilator care bundle. After knowing their learning needs, I have to develop a learning module for nurses that would be appropriate for the implementation of preferred standards of care and practices with approval from my preceptor. In my third objective which is the review and update the existing ventilator bundle protocol for the prevention of ventilator-associated pneumonia(VAP), the first thing I have to do is to make a request from the Department of Nursing Services for copies of bundle care according to protocol, policies and procedures. Then, I have to gather the existing protocol on bundle care, policies and procedures. After gathering all the documents I need, I have to examine and review step by step the existing bundle care protocol, policies and procedures. Then, I have to interview the nursing staff on their awareness of the existing protocol and make observation on the compliance of bundle care protocol. The final reports on ventilator bundle care protocol will be submitted for comments and suggestions to the Director of Nursing before the final approval. In my fourth and last objective which is to develop a sustainable prevention program for the prevention of ventilator- associated pneumonia (VAP) in long term care. It would be interdisciplinary approach, wherein I have to invite the participants to the table to present the sustainable prevention program using different approaches for the prevention of VAP. After presenting my different approaches which include: continuous staff education on prevention of VAP, surveillance on VAP through regular monitoring of bundle care using observation checklist and chart audits, strict implementations and compliance of care bundle protocol, and needed support from health care system for prevention of VAP, I have to ask their suggestions, and commitments to the program and identify their respective roles on prevention of VAP in order to have an effective and successful program. A final report on prevention program of VAP will be submitted to the Director of Nursing for review and final approval. V. Resources Human - Nursing services, infectious control, respiratory therapist, quality improvement, preceptor, administration, medical services. Physical and technical resources - ventilator bundle care protocols, policies and procedure manual respiratory therapist policies and procedures on care of ventilator patients. , infectious control statistical data on pneumonia cases VI. Formative Evaluation In formative evaluation, I will review the objectives and goals of the project and determine what types of data I will be collecting. I will conduct an observation and interviews on the nursing staff in the use of VAP bundle care and ask for feedback on the implementation process. I will provide an observation checklist for monitoring the bundle care compliance. I will provide questionnaires for nursing staff for the current practices they use and what problems and difficulties are encountered in carrying out the bundle care after which I will compile the results and find out what learning needs of nursing staff that are feasible for enhancement of bundle care. Continuous review of existing bundle care protocol is needed as well as feedback from nursing staff for implementation of best practices. In addition, a sustainable preventive program for VAP will be developed and implemented through interdisciplinary team approach identifying their roles and commitments to the program. Furthermore, feedback on the implementation of the program will be monitored for have better outcomes. VI. Summative Evaluation. In summative evaluation, I will make sure that the outcomes of the objectives were met through compliance of bundle care. Observation checklists and chart audits will be the basis for compliance to implementing bundle care protocols as well as nursing staff compliance on ventilator bundle care. In addition, the ventilator bundle protocol will be properly reviewed and updated based on the findings and recommendations from the practicum project. Furthermore, to make a sustainable prevention program for VAP, the following strategies for the development of VAP program will be considered. They include; educating the staff on VAP bundle care, strict implementation of policies and procedures, surveillance of VAP, and support from the health care system will be continuously monitored and strictly implemented and thoroughly evaluated by interdisciplinary team to ensure efficient quality of care and best health practices. References Augustyn, B. (2007). Ventilator-associated pneumonia: risk factors and prevention. Villars PS. Crit Care Nurse. 2007 Dec; 27(6):12. Harold R. Collard, Sanjay Saint, Michael A. Matthay. (2003). Prevention of Ventilator- Associated Pneumonia: An Evidence-Based Systematic Review. Annals of Internal Medicine. 2003 Mar;138(6):494-501. Tolentino-Delosreyes, Et Al (2007): "Evidence--Based Practice: Use Of The Ventilator Bundle To Prevent Ventilator-Associated Pneumonia" (American Jounral Of Critical Care – January, 2007) Coffin, S. et al. (2008). Strategies to prevent ventilator associated pneumonia in acute care hospitals. Infect Control Hosp Epidemiol 2008; 29 (Suppl 1): S31-40. Hawe, C., Ellis, K., Cairns, J.S. & Longamate, A. (2009). Reduction of ventilator-associated pneumonia: active versus passive guideline implementation. Journal, Intensive Care Medicine. Volume 35, Issue 7 , pp 1180-1186. Springer Heyland, K., Cook, J., Griffith , L., Keenan .P. & Brun-Buisson C.(1999). The attributable morbidity and mortality of ventilator-associated pneumonia in the critically ill patient. Am J Respir Crit Care Med 1999; 159: 1249-1256. Johnson, V., Mangram, A., Mitchell, C., Lorenzo, M., et al. (2009). Is there a benefit to multidisciplinary rounds in an open trauma intensive care unit regarding ventilator associated pneumonia? Am Surg.2009;75(12):1171-1174. Muscedere , G., Martin, M. & Heyland, D.(2008). The impact of ventilator-associated pneumonia on the Canadian health care system. J Crit Care 2008; 23: 5-10. Pittet, D., Allegranzi, B., et al. (2009). Evidence-based model for hand transmission during patient care and the role of improved practices. Lancet Infect Dis 2006; 6: 641-652. Richards, J., Edwards, R., Culver, D. & Gaynes, P.(2000). Nosocomial infections in combined medical-surgical intensive care units in the United States. Infect Control Hosp Epidemiol 2000; 8: 510-515. Safdar, N. & Abad, C.(2008). Educational interventions for prevention of healthcare-associated Appendix Fig 1.1. Timeline PRACTICUM 1 PRACTICUM 2 ACTIVITY No of Days MONTH 1 (Oct) MONTH 2 (Nov) MONTH 3 (Dec) MONTH 4 (Jan) MONTH 5 (Feb) MONTH 6 (Mar) 1 Preparation of project objectives, planning and consultations 1 2 4 1 Sub-Total 6 3 Data Analysis (Collection and Analysis of data collected). 6 4 Implementation and Presentation 10 Grand Total 22 Read More