Part 4: Recommending an Evidence-Based Practice Change

Part 4: Recommending an Evidence-Based Practice Change

My Workplace

– I work at TFK Hospital.
– TFK Hospital is a well-known non-profit research hospital in Georgia.
– It has 1500 beds and serves over four million people annually.
– The hospital maintains a strong culture of safety.
– Balancing patient safety with the needs of the healthcare team is a top priority for the CEO.

I am employed at TFK Hospital, a nationally recognized non-profit research hospital located in Georgia. This hospital boasts a bed capacity of 1500 and serves a population of over four million people from four counties through the dedicated efforts of more than 7500 team members. The hospital’s leadership places a strong emphasis on the connection between a positive safety culture and improved clinical outcomes. They actively promote a culture of patient safety by encouraging staff to learn from near misses and errors, investigate their causes, and develop interventions to prevent the recurrence of medical errors (Fan et al., 2016). The CEO’s primary responsibility is to strike a balance between ensuring patient safety and meeting the needs of the interdisciplinary healthcare team.

Clinical Problem

– TFK Hospital has experienced consistently high rates of ventilator-associated pneumonia (VAP) in the past two years.
– VAP is linked to increased inpatient mortality, extended hospital and ICU stays, prolonged time on ventilators, and higher medical costs.

Despite our continuous efforts to nurture a culture of safety, TFK Hospital has been grappling with consistently high numbers of ventilator-associated pneumonia (VAP) cases over the past two years. VAP is the most prevalent nosocomial infection among critically ill patients, particularly those who are mechanically ventilated and intubated (Sen et al., 2016). VAP is associated with elevated odds of inpatient mortality, extended hospital and ICU stays, prolonged time on ventilators, and increased medical costs (Sen et al., 2016).

Recommended Solution: Evidence-Based Practice Intervention

– Implementing a Ventilator Care Bundle (VCB) as an evidence-based practice (EBP) intervention.
– The PICOT question: Is the VCB more effective than usual care in reducing VAP cases among mechanically ventilated and/or intubated ICU patients six months after implementation?

I propose the implementation of the Ventilator Care Bundle (VCB), an evidence-based practice (EBP) intervention developed by the Institute for Healthcare Improvement (IHI), which has been shown to effectively reduce the incidence of VAP among critically ill patients requiring mechanical ventilation. The development and implementation of the VCB followed the EBP process, with the PICOT question stating: Is the VCB more effective than usual care in reducing VAP cases among mechanically ventilated and/or intubated ICU patients six months after implementation?

Knowledge Transfer and Dissemination

– Dissemination through unit-level or organizational-level continuous medical education forums.
– Utilizing interactive PowerPoint presentations to reach a large audience.
– Displaying posters about the EBP project in various hospital areas to stimulate discussion and further inquiries.

The design, implementation plan, and the results of the EBP project will be disseminated through unit-level or organizational-level presentations during our weekly continuous medical education (CME) sessions, which will reach a large audience of ICU staff and clinicians from other units supporting the ICU (Brownson et al., 2018). I will create interactive PowerPoint presentations and announce upcoming sessions in advance. Additionally, posters summarizing the EBP project will be prominently displayed in appropriate hospital areas to draw attention and encourage ICU and other clinicians to seek more information about the project (Conway et al., 2019).

Measurable Outcomes with EBP Implementation

– A 60% reduction in the prevalence of VAP among mechanically ventilated patients six months after implementing the VCB.
– An increase in the ICU interdisciplinary team’s knowledge of the VCB from 80% to 100% by June 1st, 2022.
– The ICU interdisciplinary team’s adherence to the VCB elements reaching 100% compliance six months after implementing the VCB.

Currently, there is no standardized practice in our ICU aimed at reducing VAP cases. The proposed EBP intervention focuses on introducing and enforcing the VCB. The expected outcomes of this EBP project are:

– A 60% reduction in the prevalence of VAP among mechanically ventilated patients six months after implementing the VCB.

Noah Caputo Dermatology Shadow Health Objective Data

– An increase in the ICU interdisciplinary team’s knowledge of the VCB from 80% to 100% by May 28, 2022.
– The ICU interdisciplinary team’s adherence to the VCB elements reaching 100% compliance six months after implementing the VCB.

Lessons Learned from Literature Review

– The four critically appraised articles included studies: a retrospective study, a systematic review, a randomized controlled trial (RCT), and a prospective cohort study.
– The retrospective nature of one study raised concerns about the validity of its findings.
– Including pre-post interventional studies in the systematic review reduced the strength and applicability of the results.

The four critically appraised articles encompassed various study designs: a retrospective study (Burja et al., 2018), a systematic review (De Neef et al., 2019), an RCT (Mahmoodpoor et al., 2017), and a prospective cohort study (Triamvisit et al., 2021). All of these articles posed focused clinical questions, clearly specifying the population of interest, interventions, comparators, and target outcomes.

From these articles, it became evident that the retrospective nature of Burja et al.’s (2018) study raised concerns about the validity of its findings. Additionally, including pre-post interventional studies in the systematic review conducted by De Neef et al. (2019) diminished the strength and applicability of the results.

– The RCT offered high-quality findings due to well-designed procedures such as randomization.
– However, it lacked a clear description of the intention-to-treat plan.
– The prospective cohort study enhanced the validity of its results through its prospective research design.

In Mahmoodpoor et al.’s (2017) RCT, the use of a computer-generated randomizer for participant allocation, blinding of the research

assistant collecting data, and comprehensive patient accounting at the trial’s conclusion contributed to high-quality findings (Mansournia et al., 2017). Randomization reduced the risk of biases, both accidental and deliberate, which could have compromised the credibility of the RCT results (Mittlböck, 2018). However, the study lacked a clear description of the intention-to-treat plan.

The prospective nature of the Triamvisit et al. (2021) study enhanced the validity of its results.

References

Burja, S., Belec, T., Bizjak, N., Mori, J., Markota, A., & Sinkovič, A. (2018). Efficacy of a bundle approach in preventing the incidence of ventilator associated pneumonia ( VAP ). Bosnia Journal of Basic Medical Science, 18(1), 105–109.

Brownson, R. C., Eyler, A. A., Harris, J. K., Moore, J. B., & Tabak, R. G. (2018). Getting the word out: New approaches for disseminating public health science. Journal of Public Health Management and Practice, 24(2), 102–111. https://doi.org/10.1097/PHH.0000000000000673

Conway, A., Dowling, M., & Devane, D. (2019). Implementing an initiative promote evidence-informed practice: Part 2 – Healthcare professionals’ perspectives of the evidence rounds programme. BMC Medical Education, 19(1), 1–17. https://doi.org/10.1186/s12909-019-1488-z

De Neef, M., Bakker, L., Dijkstra, S., Raymakers-Janssen, P., Vileito, A., & Ista, E. (2019). Effectiveness of a ventilator care bundle to prevent ventilator-associated pneumonia at the picu: A systematic review and meta-analysis. Pediatric Critical Care Medicine, 20(5), 474–480. https://doi.org/10.1097/PCC.0000000000001862