Evidence-Based Project, Part 4: Recommending an Evidence-Based Practice Change PowerPoint

Part 4: Recommending an Evidence-Based Practice Change

My Organization

oTFK Hospital

oNationally-acclaimed, private, academic, and research hospital in Georgia

o1500 beds, >4,000 patients/year

oThe positive maintains a positive culture of safety

oThere is a balance between the safety and care of patients with the interdisciplinary team members’ needs.

I work at TFKHospital, a nationally recognized, non-profit, training, and research hospital in Georgia. The hospital has a bed capacity of 1500 and it serves a population of >four million people from four counties by >7500 team members. The TFK’s leaders recognize the relationship between a positive safety culture and enhanced clinical outcomes; they continuously foster a culture of patient safety by supporting employees to learn about near misses and errors, explore flaws to comprehend their causes, design interventions to avoid recurrence of medical flaws (Fan et al., 2016). The CEO’s sole responsibility is to balance the safety and care of patients with the interdisciplinary team members’ needs. Evidence-Based Project, Part 4: Recommending an Evidence-Based Practice Change PowerPoint

Clinical Issue

o TFK Hospital recorded constantly high cases of VAP in 2 years

oVAP is associated with:

oElevated odds of inpatient mortality

oProlonged hospital and ICU stay

oExtended ventilator time

oincreased medical costs

Despite the ongoing efforts to foster and preserve a positive culture of safety, TFK Hospital has recorded a constantly high number of ventilator-associated pneumonia (VAP) infections in the past two years VAP is the most predominant nosocomial infections among severely ill patients, especially artificially-ventilated and intubated patients (Sen et al., 2016). VAP is associated with elevated odds of inpatient death, prolonged hospital and ICU stay, extended ventilator time, and increased medical costs (Sen et al., 2016).

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Recommended Solution: EBP Intervention

o Ventilator bundled is an EBP intervention proposed to reduce the risk of VAP in critically sick patients requiring mechanical ventilation.

oPICOT:

oPopulation: Critically ill patients requiring assisted ventilation

oIntervention: Ventilator care bundle

oComparison: Usual care

oOutcomes: Inpatient mortality, length of hospital and ICU stay, ventilator time, cost

oTime: 6 months

I proposed the implementation of Ventilator care bundle (VCB), an evidence-based practice (EBP) intervention developed by the Institute for Healthcare Improvement (n.d.) and has been found to successfully decrease the odds of VAP among critically sick patients requiring artificial ventilation. The development and implementation of the VCB followed the EBP process, with the PICOT (population, intervention, comparison, outcomes, time) stating: is the VCB superior to usual care in reducing VAP cases among mechanically ventilated and/or intubated patients in ICU six months after implementation?

Knowledge Transfer and Dissemination

oThe design, implementation plan, and the pre-post results of the EBP project will be disseminated through:

oUnit-level and/or organizational-level continuous medical education forums

oReach a large share of the ICU and supporting staff

oPosters pinned on various hospital noticeboards

oEncourage continued discussion about the EBP

The design, implementation plan, and the pre-post results of the EBP project will be disseminated through unit-level or organizational-level presentation during our weekly will reach a large share of the ICU staff, as well as the clinicians of other units supporting the ICU (Brownson et al., 2018). I will prepare interactive PowerPoint presentations and announce the upcoming task in the preceding the scheduled CME. In addition, posters of the EBP content will be displayed in appropriate hospital areas to draw attention to upcoming sessions (Conway et al., 2019). The poster will encourage the ICU and other clinicians to seek further explanations about the EBP project Evidence-Based Project, Part 4: Recommending an Evidence-Based Practice Change PowerPoint.

Measurable Outcomes with the Implementation of EBP

oThe prevalence of VAP among mechanically ventilated patients will increase by 60% six months after implementation of the VCB

oThe ICU interdisciplinary teams’ knowledge of the VCB will rise from 80% to 100% by June 1st, 2022

oThe ICU interdisciplinary team’s adherence to the VCB elements will improve to 100% six months after implementation of the VCB

Currently, there is no standard practice in our ICU unit aimed at mitigating VAP cases. The proposed EBP intervention focuses on the introduction and enforcement of VCB. The expected outcomes of the EBP project are:

The prevalence of VAP among mechanically ventilated patients will increase by 60% six months after implementation of the VCB
The ICU interdisciplinary teams’ knowledge of the VCB will rise from 80% to 100% by May 28, 2022
The ICU interdisciplinary team’s adherence to the VCB elements will improve 100% six months after implementation of the VCB

Lessons Learned from Literature Review

oFour articles selected

oRetrospective study

oA systematic review

oA randomized controlled trial (RCT)

oA prospective cohort study

The four critically appraised articles included studies, 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 the articles’ authors asked focused clinical questions, with a clearly defined population of interest, interventions, comparator, and target outcomes.

Lessons Learned from Literature Review

oFour articles selected

oRetrospective study

oRetrospective nature threatened validity of findings

oA systematic review

oInclusion of pre-post interventional studies diminished the cogency and applicability of the results.

From the four critically appraised articles, the retrospective nature of Burja et al. (2018) study threatens the validity of its findings, while the inclusion of pre-post interventional studies in the De Neef et al. (2019) meta-analysis diminished the cogency and applicability of the results.

Lessons Learned from Literature Review

oA randomized controlled trial (RCT)

oOffers high-quality findings due to the well-designed procedures

oUse of computer-generated randomizer

oRandomization reduced biases

oHowever, no description of intention-to-treat plan

oA prospective cohort study

oThe validity of the results are enhanced by the prospective nature of the research design.

The authors of the trial used a computer-generated randomizer to randomly assign the participants into treatment cohorts, blinded the research assistant involved in data gathering, and properly accounted for all the patients who entered the trial at its conclusion thereby decreasing the odds of attrition bias (Mansournia et al., 2017). The random allocation of the patients to the treatment cohorts decreased the odds of inadvertent or deliberate biases that might have diminished the cogency of the RCT results (Mittlböck, 2018). Nonetheless, while the patients in Mahmoodpoor et al. (2017) RCT were analyzed in their allocated intervention groups, the authors failed to provide a clear description of the intention-to-treat procedure. In the prospective study, the results’ validity are enhanced by the prospective nature of the research design (Triamvisit et al., 2021) Evidence-Based Project, Part 4: Recommending an Evidence-Based Practice Change PowerPoint.

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

References

Emptage, N., Koster, M., Schottinger, J., & Petitti, D. (2018). Critical appraisal of clinical studies: An example from computed tomography screening for lung cancer. The Permanente Journal, 11(2), 81–85. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3057745/

Fan, C. J., Pawlik, T. M., Daniels, T., Vernon, N., Banks, K., Westby, P., Wick, E. C., Sexton, J. B., & Makary, M. A. (2016). Association of safety culture with surgical site infection outcomes. Journal of the American College of Surgeons, 222(2), 122–128. https://doi.org/10.1016/J.JAMCOLLSURG.2015.11.008

Institute for Healthcare Improvement. (n.d.). Ventilator-associated pneumonia . Retrieved May 10, 2022, from http://www.ihi.org/Topics/VAP/Pages/default.aspx

Mahmoodpoor, A., Hamishehkar, H., Hamidi, M., Shadvar, K., Sanaie, S., Golzari, S. E., Khan, Z. H., & Nader, N. D. (2017). A prospective randomized trial of tapered-cuff endotracheal tubes with intermittent subglottic suctioning in preventing ventilator-associated pneumonia in critically ill patients. Journal of Critical Care, 38, 152–156. https://doi.org/10.1016/j.jcrc.2016.11.007

References

Sen, S., Johnston, C., Greenhalgh, D., & Palmieri, T. (2016). Ventilator-associated pneumonia prevention bundle significantly reduces the risk of ventilator-associated pneumonia in critically ill burn patients. Journal of Burn Care & Research : Official Publication of the American Burn Association, 37(3), 166–171. https://doi.org/10.1097/BCR.0000000000000228

Triamvisit, S., Wongprasert, W., Puttima, C., Chiangmai, M. N., Thienjindakul, N., Rodkul, L., & Jetjumnong, C. (2021). Effect of modified care bundle for prevention of ventilator-associated pneumonia in critically-ill neurosurgical patients. Acute and Critical Care, 36(4), 294–299. https://doi.org/10.4266/acc.2021.00983 Evidence-Based Project, Part 4: Recommending an Evidence-Based Practice Change PowerPoint