NURS 8114 Exploring EBP Quality Improvement
NURS 8114 Exploring EBP Quality Improvement
Evidence-Based Practice Implementation
One evidence-based practice that was implemented in the workplace to improve patient outcomes relatively recently was an oral care protocol. The goal of the protocol was to reduce the incidence of pneumonia – particularly hospital-acquired pneumonia – by introducing the protocol to adult in-patient care, especially for patients that were at-risk for infection. In late 2019, a quality of care review in the workplace had revealed an increase in hospital-acquired pneumonia incidence among the patients. After a committee was created to address this issue, the recommendation of an oral care protocol was received. The interdisciplinary team that was created for the committee recommended an oral protocol based on evidence provided in an article by Haghighi, Shafipour, Bagheri-Nesami, Baradari, & Charati that was published in 2017. The article, titled “The impact of oral care on oral health status and prevention of ventilator-associated pneumonia in critically ill patients”, was conducted in Australia, and investigated the effects of a basic oral protocol on pneumonia in adult patients. The results showed a significant positive association between taking a preventive oral care approach and health outcomes with regards to hospital-acquired pneumonia.
Application of the Evidence-Based Practice Protocol
An oral care protocol was implemented to each short-term care patient that was at-risk of developing pneumonia and was ventilated. The protocol included the introduction of a new toothbrush kit for the patients, including a suction toothbrush. The toothbrush was also designed to be ergonomically appropriate. The kit also included an alcohol-free mouthwash and baking soda toothpaste. The patients were required to continuously use the kit for the entirety of their stay. Protocol adherence was measured to be around 76 per cent. The results of the implementation showed that hospital-acquired pneumonia rates decreased from 3.82 cases per 1000 ventilator days to 1.61 cases per 1000 ventilator days. The final numbers showed that hospital-acquired pneumonia cases went down by more than half.
Evaluation and Future Challenges
The program was nurse-led, as nurses were the health practitioners that came into the most contact with these patients, and were in a better position to train patients in the kit use and monitor adherence. Thus, as a result of the protocol, nurses were able to better pneumonia outcomes by administering an oral care intervention to adult patients in the hospital.
A future challenge will be increasing the relatively low adherence rate. Despite the fact that all nurses working with ventilated adults received training on the oral care protocol, the adherence rate was far from 100 per cent. Improving adherence rates could decrease the hospital-acquired pneumonia rates significantly more than the current rates. One of the main challenges that were noted with regards to adherence were shift changes. The lack of communication about the administration of the protocol at shift change for each individual patients led to situations where some patients were not monitored for use of the kit. Including paperwork for the protocol in the chart information for each patient could improve this communication gap.
Advocacy for Evidence-Based Practice Application
In the organization, there are several ways to advocate for the application of evidence-based practice. One
method would be during the monthly continuous medical education (CME) meetings. During these meetings, volunteers present on papers or topics in healthcare relevant to practice in the institution. Presenting material on the increase in quality of care associated with evidence-based practice would advocate for its implementation within the organization.
Another method would be utilizing the hospital staff portal. Among the various pages of the organizational portal is a discussion board with a section for new or relevant research discussion. Posting articles and blogs on evidence-based practice application would boost awareness for interested staff members, and act as advocacy.
Lastly, approaching hospital administration with potential evidence-based practices and protocols would advocate for their application. Including briefs on how these practices would improve care quality, decrease hospital costs, or improve worker productivity would increase their chances of being implemented. Overall, this is a more direct method of advocacy.
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Haghighi, A., Shafipour, V., Bagheri-Nesami, M., Baradari, A. G., & Charati, J. Y. (2017). The impact of oral care on oral health status and prevention of ventilator-associated pneumonia in critically ill patients. Australian Critical Care, 30(2), 69-73.
Ventilator Associated Pneumonia (VAP) is a nosocomial infection that is not present at the time of intubation. It develops 48 hours after the initiation of mechanical ventilatory support. Evidenced-based guidelines prove that VAP prevention is possible through the implementation of certain VAP prevention bundle interventions (Osman et al., 2020). The risk of developing pneumonia increased 5 to 10 times if patients are transferred to the intensive care unit and grow 20 times in patients mechanically ventilated. Patients in the ICU have a higher incidence of VAP. VAP is the second most acquired HAI and studies are showing it is preventable (Mahmudin, et al., 2020).
The major route for acquiring VAP is oropharyngeal colonization. The prevention of VAP is to focus on aspects of care influencing this process. The first 48 hours is a crucial time because this is the time it takes for VAP to develop. Some factors affecting the pathogenesis of VAP are oral hygiene which will aid in changing the cavity flora. The VAP prevention bundle is a series of care interventions for patients with mechanical ventilators. It was originally designed to treat patients with ventilation devices. However, when the prevention bundle was implemented, institutions saw a significant decrease in the prevalence of VAP. Each VAP prevention bundle is also an infection control tool. The VAP prevention bundle includes elevating the head of bed to 30 degrees or greater, every two hour oral hygiene, assessment of sedation, peptic ulcer prophylaxis, blood pressure control, suctioning the endotracheal tube, and emptying the condensation from the ventilator tubing (Mahmudin, et al., 2020).
Your post was very informative, I further expanded on VAP for my own benefit.
Mahmudin, A. A., Chalidyanto, D., Martanto, T. W., Semedi, B. W., Yulaicha, & Solichah.
(2020). Reducing incidence rate of ventilator-associated pneumonia (VAP) using prevention bundle in the ICU. EurAsian Journal of Biosciences, 14(2), 3193–3199.
Osman, S., Al Talhi, Y. M., AlDabbagh, M., Baksh, M., Osman, M., & Azzam, M. (2020). The
incidence of ventilator-associated pneumonia (VAP) in a tertiary-care center: Comparison between pre- and post-VAP prevention bundle. Journal of Infection and Public Health, 13(4), 552–557. https://doi-org.ezp.waldenulibrary.org/10.1016/j.jiph.2019.09.015
Nice Post! Evidence-based practice offers a conscientious, problem-solving strategy to clinical practice by combining the best and most compelling evidence from patient preferences, well-designed studies, patient values, and clinician’s expertise to enhance decisions on a patient’s care. Being knowledgeable about various evidence-based practices are important for every nurse and clinician to be confident with the intervention being used to treat or manage a disease. In order to deliver high-quality care, evidence-based practice needs to continue to be developed. While there may be pros and cons related to the development of EBP, it is the foundation of nursing as it applies to standards of care. Without EBP, the nursing profession could not exist. Nurses are required to gain knowledge every year before they can renew their licenses. If there were no new EBP to learn, the education would be the same all the time, reducing patient outcomes.
Melnyk, B. M. (2011). Evidence-based practice in nursing & healthcare: a guide to best practice (2nd ed.). Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.