Evaluation framework and variables for assessing ventilator-associated pneumonia outcomes

¶ … Baker, 2000).The measurement of project effectiveness, an element of project impact evaluation, is crucial for the success of every proposed project. In this section, we present the method/mechanism for evaluating the effectiveness of the proposed solution. The process starts with the identification of the project users (Ventilation associated pneumonia patients), gathering data to be used in determining if the user received output, identification of process of transmission and ends up with the change process. This is indicated in the flowchart model (see figure 1.) which provides for an elaborate systematic way of examining the process within the proposed project and the outcome of the proposed project. The evaluation of the outcomes is the major purpose of the framework even though the outcomes can never be seen in total isolation of the proposed project "mechanics" (including transmission, project reception as well as use).At certain points in the project evaluation framework, it is absolutely necessary to king of "go back" and effectively examine the absolute effectiveness of the mechanical stages in the project evaluation project and the resultant expected change.

Figure 1.

The variables to be assessed when evaluating project outcomes

The variables to be assessed when evaluating project outcomes are numerous. They include the following.

1. Ventilator days (VD)

2. VAP, No. (%) of patients

3. VAP rate (per 1000 VD)

4. MICU patient days (PD, all patients

5. Utilization ratio (VD/PD)

6. Duration of ventilation, mean, days

7. Days in MICU (ventilator patients), mean

8. Time to VAP, mean, days

9. Mortality (ventilator patients), No. (%)

Ventilator days (VD)

A ventilator day is the number of days in which a given patient is placed on a ventilator as part of his or her treatment regiment. The risk and costs associated with VAP increases with an increase in the number of ventilator days (VD) (Hugonnet et al.,2004).

VAP, No. (%) of patients

The variable VAP, No. (%) of patients indicates the number of patients suffering from VAP out of the general patient population.

VAP rate (per 1000 VD)

The variable VAP rate (per 1000 VD) indicates the rate of VAP per a thousand ventilator days.

MICU patient days (PD, all patients)

The variable MICU patient days (PD, all patients) denotes the total number of days that all patients in Medical Intensive Care Unit (MICU) take before death or discharge.

Utilization ratio (VD/PD)

The variable Utilization ratio (VD/PD) denotes the total number of ventilation days which were beneficial to the patient before they got discharged or contracted VAP.

Duration of ventilation, mean, days

This variable denotes the average duration in terms of days that a patient was under ventilation (using a ventilator).

Days in MICU (ventilator patients), mean

This variable denotes the total number of days that ventilator patients in Medical Intensive Care Unit (MICU) take before death or discharge.

Time to VAP, mean, days

This variable denotes the average number of days before a patient contracted VAP.

Mortality (ventilator patients), No. (%)

This variable denotes the rate of death of ventilator patients as a result of VAP.

The developed tools necessary for educating project participants

Several tools will be used in educating the project participants. These tools are necessary to enable the project participants come to an absolute understanding of the project mechanics. Some of these tools are used in data collection such as questionnaires while others are purely for research and educational purposes. The ones for research and educational purposes include computer systems and resources like the internet, blackboard that are used in seminars, peer reviewed medical and clinical journals on VAP, projector, photo slides, PowerPoint presentations, medical abstracts among many others.

Assessment tools necessary to for the evaluation of project outcomes

The assessment tools will include an evaluation test. The test will be used for evaluating the effectiveness of the education activity before exposing the participant to the core project details. The other tool used in the ventilator bundle audit tool. This was developed by the implementation team to help in keeping of the electronic medical records of each and every ventilator record.The tool iis important since it can record, accurately, all the patient ventilator variables like sedation vacation, HOB elevation > 30 degrees, DVT prophylaxis implementation, sedation vacation in last 24-hour, oral care every 4 hours etc. The level of compliance with the VAP bundle can be measured by an assessment of the time of completion.

The distribution of the result

The spread of the outcome of the new prevention practices to a nursing community and to a number of key stakeholders is a significant way in the implementation of the project. So often, clinicians, healthcare institutions and other departments of nursing normally fail to learn the success of the project change because the results of these projects are not distributed. As a result, most changes which are experience are positive and often isolated; when in reality they can create many widespread results.

Strategy used in the disseminating results of project to key stakeholders

A number of stakeholders who are affected as result of changes which occurred due to the establishment of the new practices to reduce VAP are normally the healthcare staff of the hospital ICUs. The hospital clinical practices committee and the nurse research council is formed to inform and keep the project implementation team updated time to time. During the time of implementation, there are supposed to a weekly staff meeting where the project is discussed into details. According to the recommendation given by Gawlinski (2007), the results obtained from the project are used in writing new guidelines, procedures and workplace competencies within the hospital ICU units. The team who are involve in the hospital wide internet to share the result of the project implementation to every clinician in the hospital. However, news letter articles, staff meetings, journal clubs, EBP rounds and posters in the place of work are used to distribute the result.

Strategy in disseminating significance of project outcomes to nursing community

In spreading the result of the greater nursing community, the project and its implementation details are published in the nursing journals. An article with a title of Interventions by ICU nurses in reducing VAP is published in nursing and medical journals including American Journal of Crital care (AJCC). Oermann et al. (2010) noted that nursing journals normally plays an important role in the distribution of the result of evidence-based practices project implementations. Despite the measures the project team is supposed to make sure that all the guides of the dissemination plans are approached keenly so that team improves and make it easier to reach dissemination goals. The spirit of the team promotes a more understanding culture among the participants. In addition, Walsh (2010) stated that team work shares the accountability and obligation of project participants in the entire EBP implementation process, which has a results to improve the healthcare system in general.