Compliance with ventilator care bundles in reducing ventilator-associated pneumonia

Compliance to Ventilator Care Bundles on Reducing Ventilator-Associated Pneumonia

Ventilator-Associated Pneumonia (VAP) is a common infection that is acquired by patients who have used mechanical ventilation in health care facilities. This infection has generated numerous concerns in public health because of its negative impacts on health care. Some of these negative health effects include extended hospital stays, increased costs of health care services, and deaths. Consequently, there have been numerous initiatives in healthcare to address this problem including ventilator care bundles. Existing literature on evidence-based practice for dealing with VAP has shown that compliance with ventilator care bundles is the most suitable clinical intervention (Al-Thaqafy, 2014). For this study, the John Hopkins Nursing Evidence Practice Process will be utilized to facilitate compliance to these bundles in order to reduce VAP. John Hopkins developed an equation that helps administrators quantify probable savings through lessening hospital-acquired infections like VAP (Guterl, 2013). This process will entail research (reviewing existing literature on the topic), conducting nursing education, and implementing suitable nursing practices.

Step 1 -- Recruit Interprofessional Team

A dedicated interprofessional or multidisciplinary team is crucial towards compliance to ventilator care bundles to reduced VAP infections. This interprofessional team will consist of five members who will be part of the primary intensive care unit. These members will include a physician, a respiratory therapist, a pharmacist, a charge nurse, and a clinical nurse specialist.

Step 2 -- Develop and Refine the EBP Question

In regards to patients on ventilators, how effective is compliance to VCP bundle protocols vs. noncompliance with VC bundle protocols in reducing the risk of patients acquiring Ventilator Associated Pneumonia. The population of interest is patients suffering from Ventilator Associated Pneumonia while the intervention in compliance to VC bundle protocols. The comparison is whether compliance to VC bundle protocols lessens risk of acquiring VAP as compared to noncompliance whereas the outcome is reduced VAP infections.

Step 3 -- Define the Scope of the EBP

Recent studies have indicated that VAP has an incidence rate of between 5% and 67% in intensive care units and a mortality rate of between 24% and 76%. The condition contributes to extended hospital stays by approximately 9 days and increases the costs of care. This essentially means that VAP is a public health problem because of its considerable negative impacts including extended hospital stays, increased costs of health care services, and death (Lawrence & Fulbrook, 2011). Therefore, VAP impacts healthcare through increasing hospitalization, generating poor clinical outcomes, and increasing costs of care (Guterl, 2013).

Step 4 and 5 - Determine the Responsibility of Team Members

The physician will help coordinate care in a manner that complies with VC bundle protocols to reduce risk of VAP infections. The role of the pharmacists will be to provide proper medication based on physicians recommendations while the respiratory therapist will examine the patient's respiratory health and provide modifications and/or recommendations for preventing VAP. The nurse will help ensure that the patient maintains good oral hygiene and maintain him/her in a semirecumbent position while the charge nurse specialist measures compliance with VC bundle protocols.

Step 6 and 7 -- Conduct Internal/External Search and Appraisal of Evidence

Existing studies recommend compliance with VC bundle protocols as evidence-based practice guidelines for lessening this hospital-acquired infection. A qualitative research by Lawrence & Fulbrook (2011) states that implementation of VC bundles is associated with improved clinical outcomes. The strength of this qualitative research is that the exploration was carried out on several studies that were published between 2004 and 2009. A quantitative study by Rello et al. (2012) contended that implementing VC bundles reduces risk of VAP infection and its associated health effects on patients. The strength of this study is that the cohort research was carried out in five Spanish adult intensive-care units. The position of these studies is that evidence-based practice demonstrates that compliance to VC bundles not only reduces VAP but also mitigates its impacts on patients.

Step 8 and 9 -- Summarize the Evidence

Rello et al. (2012) found that high compliance with VC bundle protocols helps in preventing VAP infections in intensive care units while low levels of compliance also generate significant benefits. Lawrence & Fulbrook (2011) seemingly disagrees by arguing that a definite causal link between use of VC bundles and VAP reduction cannot be explicitly stated. However, strong evidence exists in literature to show a positive link between the two. Similar to Rello et al. (2012), Mukhtar et al. (2014) found that compliance with VC bundles lessens incidences of VAP and its effects like extended hospital stays. Al-Thaqafy et al. (2014) holds the same view by stating that increased compliance to VC bundle protocols generates decreased rate of VAP.

Step 10 -- Develop Recommendations for Change Based on Evidence

Based on the evidence in literature, one of the recommendations for compliance with all components of VC bundle protocols is enhancing knowledge of nursing staff on ventilator bundle practices. This will entail providing data on rates of VAP at the hospital and the impact of complying with VC bundle protocols on decreased rates of this hospital-acquired infection. Secondly, measures of evaluating or measuring compliance with VC bundles should be created in intensive care units and specific professionals mandated with the task of carrying out the measurements. Third, nurses should ensure that suitable conditions that prevent VAP are established in the hospital and ensure patients are effectively monitored and managed.

Step 11, 12 and 13, 14 -- Action Plan

The first step in this pilot study will be to conduct a one-week workshop for nurses and other health care providers in the intensive care unit on ventilator associated pneumonia. This will be followed by providing data regarding current VAP rates at the unit and the level of compliance. The next step in this process will be to provide nursing staff with daily goal sheets that will track a nurse's compliance with the various components of VC bundles and ensuring every patient complied with these components. Nurses will be required to fill out these goal sheets at the end of their shifts and submit them on a daily basis for a one-month period. The final step in the pilot study will entail examining VAP rates and the levels of compliance with VC bundle protocols based on information provided by nursing staff in the daily goal sheets.

Step 15 and 16 -- Evaluating Outcomes and Reporting Outcomes

The desired outcomes of this pilot project is lessening the rates of ventilator associated pneumonia in the unit and enhancing compliance with VC bundle protocols. These outcomes will be measured by evaluating information provided by nursing staff in the daily goal sheets, examining clinical outcomes, and comparing VAP rates before and after implementation of the pilot project. The results of this project will be reported to key stakeholders through a meeting where the data will be presented and publishing a newsletter on the same.

Step 17 -- Identify the Next Steps

The plan will be implemented on a larger scale through holding a meeting with the facility's management regarding the findings of the pilot project and how it can implemented on a larger scale. This will be followed by creating buy-ins for implementing these procedures throughout the health care facility. The other step in implementing this project on a larger scale will be to conduct staff education on VAP rate prevention and compliance with VC bundle protocols and providing them with necessary resources for implementation based on their respective roles and responsibilities. To ensure the implementation becomes permanent, necessary resources will be provided while periodic reviews are carried out. Information from the periodic reviews will be utilized to enhance the project vis-a-vis its desired outcomes.