Jan 25, 2018 in Research

Implementation Plan to Prevent VAP

With consideration to the strong evidence-based practice that has for many decades proven that oral practices can be implemented and effected through determination and utter efforts, this paper presents the implementation plan based on strategies that best serves oral care needs of the medical institution the author works with.

Description of the Problem

Different patients attending hospitals are worried about their funding, while others are worried about the duration they may spend in hospitals. With regards to Ventilator Associated Pneumonia (VAP), patients worried about the cost of funding for their treatments have to part with $30,000 to $40,000 if dental care is not managed properly to keep VAP in check. On the other hand, the number of days or the duration that a patient has to stay in hospital is also prolonged if management of VAP causal elements is not kept under check. It has come to the attention of medical practitioners that VAP is a major medical concern in critical care settings in the contemporary nursing settings. VAP occurs as a result of microorganisms that build up in the oropharynx adhering to the dental colonization, while colonizing the dental cavity and the endotracheal tube. The shift of these microorganisms to the lungs results into pneumonia. Statistics show that 75% of ventilator patients have pneumonia and about 90% of all pneumonia cases for ventilator patients in the critical care settings are VAP associated. With consideration to the number of preventive measures that can be established, oral care is imperative in reducing the rate of occurrence of VAP. Contemporarily, improved oral care has decreased the rate of VAP cases in various institutions as well as the authors. This plan is not aimed to reduce VAP any further, but to eradicate the condition completely. Taking a research-based approach, the author was a part of a 48-month study to establish the rate of occurrence of VAP at the Brookdale University Hospital and Medical Center, a 427-bed institution. The study focused on 10-bed ICU with the selection criterion based on patients admitted within a period of 48 hours or less. The patients admitted were prospectively followed up for the occurrence of VAP until they were dismissed from ventilation in the medical intensive care unit (ICU).

Approval and Support

The study will involve practitioners meeting the following criteria: nurses with more than five years of experience, charge nurses, nurse manager, study nurses, pharmacist, physician, and infection control nurse. The collection of data will feature the last 48 months with respect to the prevalence rate of the VAP and presentation of the data to the authority will be effected thereafter. In search for approval of the study, the author will take the initiative to lay down the facts regarding oral care and the cause of VAP. These facts will reference evidence-based literature on the subject so as to maintain relevance and state purpose of the study. The proposed oral care will be presented to the nursing officer, the organizational review board, and the research committee member for approval of the research (Melnyk & Fineout-Overholt, 2011). Close comparison of the cost of treating VAP and the acquisition of supplied shows that the former is costly and may put the hospital in economic jeopardy. Given that the elimination of VAP is the goal of this study, the hospital would be able to operate sustainably after the VAP cases are eradicated. Given that most of the times insurance covers of patients cater for the hospital bills, this research will aim at relieving patients from hefty medical budgets. With the above outlined reasons as to why oral care is necessary for the ICU cases in the prevention of VAP, the project meets the minimum requirements for approval.

Proposed Solution

Regardless of whether the experiences and skills of the hospital’s staff are known or not, oral care practices within the hospital were practiced. As an emphasis on the relevance and significance of this study, the implementation of oral care to counter VAP will be aimed to fight back stress to both the patient and his/her family, reduction of the duration a patient takes under ventilation, and elimination of cumulative costs associated with the prolonged admissions. While financial costs of the VAP are elements influencing this research, the value of life is a major motivation that the author aims to preserve for patients in the ICU. The morbidity and mortality rates of all ICU patients will be increased as some of the major benefits of eradicating VAP in the critical care settings will be obtained. Proposed strategies that will see this plan a success include changes of the ventilator circuit every 7 days, replacement of the heat-moisture exchange filter every 24 hours, changes of the closed suction catheter after every 24 hours (here suctioning will be performed after very two hours), the use of a 30-degree semi-recumbent positioning protocol when medically viable, administration of prophylaxis of stress ulcer, and the incorporation of an active weaning protocol. Compliance of the above interventions has to be above 90% to ensure and guarantee effectiveness of the plan. The plan is divided into two sets of intervention stages that involve pre-intervention and intervention period (Lippincott & Wilkins, 2008).

The pre-intervention period is 2 years, in which infection control professionals embarked on staff interviews and observations to scrutinize the possible barriers to best practice in VAP prevention. Prior to the implementation of the plan, several concerns were noted by the infection control. These included the lack of daily assessment of oral tissues and teeth, disconnection of the closed suction tubing to suction oral secretion, inadequate suctioning of oral secretions accumulating in the cavity, and poor practices relating to the care of oral gums and tissues. To intervene effectively, the author seeks collaborative efforts aimed at addressing the issues raised above to ensure cost effective and accurate intervention to the problem of VAP. Caution is taken at the implementation stage in that no dental care products are to be used, hence standard oral care is maintained. It is through the concerns of negligence and/or the lack of experience or commitment that may render the exercise a failure. In this case, the staff members of this plan are to be trained using the contemporary oral care methods, and presentations on how to execute the oral care protocols will be employed as well.

Evidence from Literature Review

One author support the idea that oral care can increasingly decrease the negative effects of VAP for patients receiving mechanical ventilation. In this case, it has been recommended in various studies and literature that oral hygiene must be maintained in order to effectively eliminate VAP. According another author, a daily assessment to evaluate the levels of oral infections and functions should be implemented to make sure that practitioners provide the most appropriate care to patients. In addition, while the nursing setting may involve the use of various dental care methods, it is claimed that teeth brushing is one of the most cost-effective oral care methods that should be implemented to ensure standard oral hygiene. Teeth brushing is effective in that it prevents the formation of dental plague in all cases besides ventilator-supported patients. An author Henneman acknowledge that oral cleansing after every 2 or 4 hours promotes healing and maintains the integrity of oral tissues. He recommended the use of an alcohol-free oral antiseptic rinse to limit or prevent the bacterial load and colonization of the oropharyngeal area. Henneman argues that routinely suctioning of the mouth and pharynx is effective in the management of oral secretions, and it minimizes the risk of the oral mucosa. Some authors outline that the application of a water-based mouth moisturizer is recommended to maintain the integrity of the oral mucosa (Swearingen, 2012).

Studies show that the implementation of a multifaceted strategy was more effective than single-faceted strategy in the prevention of VAP. The outlining of specific care protocols and measures enables constancy and eminence care through normalization. In the implementation of any intervention plan, it was recommend that practitioners should be able to observe current practice of oral care in patients receiving mechanical ventilation, evaluate a number of best practices, and measure the compliance of an intervention of standardized oral care.

Implementation Logistics

The study period intended by the author and the supporting team will be 48 months, and this duration will be divided into two stages. The first stage will be a pre-intervention stage aimed to collect data regarding staff members as well as establish areas of concern by the infection control professionals. The second stage will be on implementation, which will take exact time frame as the first stage. The first stage will involve scrutinizing of the supporting team; this will involve training recommendations for the members who will not be conversant with specific areas on oral care, VAP prevention, and the collection of data. In the second stage, implementation of the intervention stage would take effect with brief weekly meetings and monthly meetings both aimed at confirming on-time schedule and proper implementation progress (Haag-Heitman & George, 2011).

Resources for the Project

With consideration to the time scope of the research, the project on VAP will require support from the resource personnel, such as the infection control, research nurses, pharmacists, physicians, and staff members of the MICU. The supporting team will conduct two tests, which will comprise of a pretest and a posttest, to evaluate the proficiency of the staff members. The infection control professionals will conduct a study aimed at determining the oral care constraints that may have been documented in earlier studies and how to avoid them in the current study. Data collected will be saved in a computer or computer-based devices for easy access and manipulation. While the time scope of this study is broad, the financing of the project will depend on the management resourcefulness. In addition, the members of the project are urged to be creative in promoting this initiative and sensitizing the public to help in raising funds to support this project (Mainous & Pomeroy, 2010). Ethics of the research will be observed to minimize liabilities with patients and the hospital at large. Hospital policies will be adhered to in order to avoid risks or to manage risks within a deliverable approach, which will not consume further time in creating and implementing.


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