ACE Star Model Of Knowledge Transformation: EBP Change Process
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Star Point 1: Discovery (Identify topic and practice issue)
Identify the topic and the nursing practice issue related to this topic. (This MUST involve a nursing practice issue.)
Ventilator-Associated Pneumonia (VAP) is a perfect example of healthcare-associated infection (HAI) in healthcare facilities particularly among adult hospitalized patients in ICU settings. As a gradually emerging concept, it remains to be an important problem among critically ill patients that results in serious complications. Therefore, the subject of evaluation is the increasing incidence of ventilator-associated pneumonia (VAP) among adult hospitalized patients under intubation or mechanical ventilation in ICU settings ACE Star Model Of Knowledge Transformation: EBP Change Process.
Briefly describe your rationale for your topic selection. Include the scope of the issue/problem.
Ventilator-Associated Pneumonia is a leading cause of mortality, morbidity, increased medical costs, prolonged hospital stays and poor health outcomes across healthcare settings in the United States. It particularly occurs among hospitalized patients in the ICU between 48-72 hours after mechanical ventilation or intubation. Its primary characteristics include signs of systemic infection, sputum changes, and continuous infiltration. As the contributor of half of all the hospital-acquired pneumonia infections, its prevalence has been estimated to be between 8-40% with the highest risk occurring within the 1st five days of admission. It has contributed to a reduction in patient safety and made healthcare organizations inefficient to execute the role of providing high quality, efficient and effective care. This explains why it is vital to define the clinical issue and its causes to develop effective intervention measures to prevent or reduce the incidences of Ventilator-Associated Pneumonia.
Star Point 2: Summary (Evidence to support the need for a change)
Describe the practice problem in your own words and formulate your PICOT question.
Critically ill patients who might be under sedation or unconscious while receiving treatment in the ICU/CCU setting require the support of ventilator machines to breathe properly. However, using these machines (mechanical ventilation) or intubation for more than 48 hours can lead to ventilator-associated pneumonia (VAP) which is a serious complication among critically ill patients. It is associated with prolonged stays in the hospital, prolonged periods of mechanical ventilation, additional medical costs, increased morbidity, and double mortality risk. Therefore, considering the risks associated with VAP, reduction or prevention should be a priority for nursing care.
PICOT Question-In adult patients aged 40 years or older under intubation or mechanical ventilation in ICU settings (P) will the use of 0.2% oral chlorhexidine (I) compared to the use of normal saline(C) decrease the rate of Ventilator-Associated Pneumonia(O) from 16% to 10% within 6 weeks(T)?
List the systematic review chosen from the CCN Library databases. Type the complete APA reference for the systematic review selected.
Klompas, M., Speck, K., Howell, M. D., Greene, L. R., & Berenholtz, S. M. (2014). Reappraisal of routine oral care with chlorhexidine gluconate for patients receiving mechanical ventilation: systematic review and meta-analysis. JAMA internal medicine, 174(5), 751-761.
List and briefly describe other sources used for data and information. List any other optional scholarly source used as a supplement to the systematic review in APA format.
- 1. Alimi, M., Manzari, Z. S., Bagheri Moghadam, A., & Rouhani, H. (2016). Evaluation of the Effects of Oronasal Versus Oral Disinfection with Chlorhexidine on Clinical Criteria of Ventilator-associated Pneumonia. Evidence-Based Care, 6(3), 19-30.
- Zhang, T. T., Tang, S. S., & Fu, L. J. (2014). The effectiveness of different concentrations of chlorhexidine for prevention of ventilator‐associated pneumonia: a meta‐analysis. Journal of clinical nursing, 23(11-12), 1461-1475.
- Villar, C. C., Pannuti, C. M., Nery, D. M., Morillo, C. M., Carmona, M. J. C., & Romito, G. A. (2016). Effectiveness of intraoral chlorhexidine protocols in the prevention of ventilator-associated pneumonia: a meta-analysis and systematic review. Respiratory care, 61(9), 1245-1259.
Briefly summarize the main findings (in your own words) from the systematic review and the strength of the evidence.
One of the major roles of healthcare providers is to prevent patient harm by enhancing safety. Based on the high incidences of VAP, nurses must implement effective measures to promote health outcomes. The rise in VAP infections has been attributed to oral hygiene due to the use of mechanical ventilators and intubation. The findings from the systematic review revealed that 0.2% oral chlorhexidine is effective in preventing VAP among adult patients in ICU settings as compared to normal saline ACE Star Model Of Knowledge Transformation: EBP Change Process. Thus its use should continuously be encouraged in ICU settings and be integrated into the management of patients.
Outline one or two evidence-based solutions you will consider for the trial project.
Using 0.2% oral chlorhexidine to maintain oral hygiene is vital in preventing and reducing Ventilator-Associated Pneumonia. 0.2% oral chlorhexidine decreases colonization of the oral cavity by bacteria which are the major pathogens that cause infection. Chlorhexidine decreases the risk of respiratory infections before, during and after intubation or mechanical ventilation.
An alternative solution is the use of normal saline and tooth brushing to maintain oral hygiene. However, there is limited evidence that supports their effectiveness in VAP prevention and related health outcomes. On the other hand, existing evidence recommends it as part of the VAP care bundle that should be given to patients alongside the use of oral chlorhexidine.
Star Point 3: Translation (Action Plan)
Identify care standards, practice guidelines, or protocols that may be in place to support your intervention planning (These may come from your organization or the other sources listed in your Summary section in Star Point 2).
The 2003 Centers for Disease Control Guidelines for Preventing Healthcare-Associated Pneumonia and the 2004 CDC Guidelines for the Management of Adults With Hospital-Acquired, Ventilator-Associated, and Healthcare-Associated Pneumonia give recommendations and guidelines that should be followed by healthcare providers to prevent, reduce and manage Ventilator-Associated Pneumonia.
List your stakeholders (by title and not names; include yourself) and describe their roles and responsibilities in the change process (no more than 5).
Management: development of practice guideline, care protocols, and policies to promote quality, safety and effectiveness in patient care. It also plans for seminars, conferences, and training for staff on basic standard operating procedures ACE Star Model Of Knowledge Transformation: EBP Change Process.
Physicians: directly involved in patient care by recommending ways and procedures to improve patient outcomes
Critical Care Nurses: directly involved in patient care by recommending ways and procedures to improve patient outcomes, coordinate patient care, administer medications and nurse patients.
Patients: Collaborate with all healthcare providers by providing relevant medical information that can be used in decision making at the point of care.
What specifically is your nursing role in the change process? Other nursing roles?
Nurses are first-line communication managers who ensure coordination of care with families and other healthcare providers for all patients in the ICU. They administer medications, monitor the patient for potential adverse effects and institute appropriate intervention measures where necessary to safeguard patients from harm.
List your stakeholders by position titles (charge nurse, pharmacist, etc.).-Why are the members chosen (stakeholders) important to your project?
Critical Care Nurses-4-Should implement the proposed care protocol and guidelines in terms of administration and care coordination with families and other healthcare providers
Critical Care Physicians-3 should ensure that all decisions made in prevention or management of patients with VAP follow the prescribed guidelines and protocol.
What type of cost analysis will be needed before a trial? Who needs to be involved with this?
Before the implementation of a trial, cost-effectiveness analysis and cost-benefit analysis will be needed. The primary costs will be incurred in the training of staff and the purchase of 0.2% oral chlorhexidine. Close to 8 physicians and 10 nurses will undergo the training in the trial period. Besides, there will be ongoing education to sensitize and increase awareness of other staff on the prior trial. This education will be conducted using flashcards, checklists, and brochures ACE Star Model Of Knowledge Transformation: EBP Change Process.
Star Point 4: (Implementation)
Describe the process for gaining permission to plan and begin a trial. Is there a specific group, committee, or nurse leader involved?
The critical care nurse head and the critical care physician head will write to the hospital’s leadership to seek permission to conduct the trial. This should include the clinical problem identified, its impacts on patients, staff and the organization and why change is essential. A detailed description of the proposed intervention measures to be implemented in the change process and the expected outcomes should also be included.
Describe the plan for educating the staff about the change process trial and how they will be impacted or asked to participate.
All the staff directly and indirectly involved in the change process will be educated on the change through a training program that will take place for one week. Staff will be asked to participate by availing themselves for training, recommending alternative changes and to propose measures for intervention. Staff will also be asked to provide feedback which will be used to make improvements in other areas of practice.
Outline the implementation timeline for the change process (start time/end time, what steps are to occur along the timeline).
17-9-2019 to 13-10-2019-Staff training on change
14-10-2019 to 21-10-2019-Printing sensitization and awareness resources
22-10-2019 to 10-11-2019-Developing guidelines, protocols, and policies on the use of Oral Chlorhexidine to reduce VAP
11-11-2019 to 25-11-2019- Evaluating outcomes in skills and knowledge
List the measurable outcomes based on the PICOT. How will these be measured?
Ventilator-associated pneumonia, duration of mechanical ventilation, mortality, antibiotic prescribing, intensive care unit and hospital length of stay
What forms, if any, might be used for recording purposes during the pilot change process. Describe.
During the pilot change process, it will be necessary to use mortality and morbidity forms, epidemiology forms and financial and utilization forms ACE Star Model Of Knowledge Transformation: EBP Change Process. Each of these forms will later be used to compare and measure baseline data and outcome data before and after the pilot change process.
What resources are available to staff (include yourself) during the change pilot?
Funds to facilitate training and purchase of oral chlorhexidine, a fully equipped 12 capacity ICU, wristwatches, pens, booklets, and flash disks will be provided during the change pilot.
Will there be meetings of certain stakeholders throughout the trial? If so, who and when will they meet?
The critical care nurses, physicians and a representative from the hospital’s leadership who are directly involved in the trial will meet daily in the entire trial period to assess the progress made through feedback. The meeting will purpose to provide daily reports that will be used to determine the benefits versus risks of the trial to the patients, healthcare providers, and the organization. Based on this information, decisions on whether or not to continue with the trial and other relevant adjustments will be made.
Star Point 5: (Evaluation)
How will you report the outcomes of the trial?
The trial committee will write a detailed report that describes the outcomes and findings, which will later be published in a peer-reviewed journal.
What would be the next steps for the use of the change process information?
This information will be used by the organization’s quality improvement committee to implement the proposed change within the organization, to positively influence patient health outcomes, organizational performance, and staff satisfaction.
Reference
Klompas, M., Speck, K., Howell, M. D., Greene, L. R., & Berenholtz, S. M. (2014). Reappraisal of routine oral care with chlorhexidine gluconate for patients receiving mechanical ventilation: systematic review and meta-analysis. JAMA internal medicine, 174(5), 751-761 ACE Star Model Of Knowledge Transformation: EBP Change Process.
Week 6 Assignment: EBP Change Process form
ACE Star Model of Knowledge Transformation
Follow Nurse Daniel as your process mentor in the weekly Illustration section of the lesson. Please do not use any of the Nurse Daniel information for your own topic, nursing intervention, or change project. Nurse Daniel serves as an example only to illustrate the change process.
Name: _____________________
Star Point 1: Discovery (Identify topic and practice issue)
Identify the topic and the nursing practice issue related to this topic. (This MUST involve a nursing practice issue.)
Briefly describe your rationale for your topic selection. Include the scope of the issue/problem.
Star Point 2: Summary (Evidence to support need for a change)
Describe the practice problem in your own words and formulate your PICOT question.
List the systematic review chosen from the CCN Library databases. Type the complete APA reference for the systematic review selected.
List and briefly describe other sources used for data and information. List any other optional scholarly source used as a supplement to the systematic review in APA format.
Briefly summarize the main findings (in your own words) from the systematic review and the strength of the evidence.
Outline one or two evidence-based solutions you will consider for the trial project.
Star Point 3: Translation (Action Plan)
Identify care standards, practice guidelines, or protocols that may be in place to support your intervention planning (These may come from your organization or from the other sources listed in your Summary section in Star Point 2).
List your stakeholders (by title and not names; include yourself) and describe their roles and responsibilities in the change process (no more than 5).
What specifically is your nursing role in the change process? Other nursing roles?
List your stakeholders by position titles (charge nurse, pharmacist, etc.).–Why are the members chosen (stakeholders) important to your project?
What type of cost analysis will be needed prior to a trial? Who needs to be involved with this?
Star Point 4: (Implementation)
Describe the process for gaining permission to plan and begin a trial. Is there a specific group, committee, or nurse leader involved?
Describe the plan for educating the staff about the change process trial and how they will be impacted or asked to participate.
Outline the implementation timeline for the change process (start time/end time, what steps are to occur along the timeline) ACE Star Model Of Knowledge Transformation: EBP Change Process.
List the measurable outcomes based on the PICOT. How will these be measured?
What forms, if any, might be used for recording purposes during the pilot change process. Describe.
What resources are available to staff (include yourself) during the change pilot?
Will there be meetings of certain stakeholders throughout the trial? If so, who and when will they meet?
Star Point 5: (Evaluation)
How will you report the outcomes of the trial?
What would be the next steps for the use of the change process information? ACE Star Model Of Knowledge Transformation: EBP Change Process