The patient will maintain adequate breathing pattern to provide appropriate oxygenation and acid/base balance while providing respiratory muscle rest.The incidence for VAP will be reduced due to EBP pilot project interventions. The research supports our clinical question and was utilized with the development of additions to be incorporated into the already existing ICU VAP protocol. C.Utilize oral airway if patient is obstructing oral endotracheal tube. These measures will motivate the staff for a change in practice. Enter the last name, specialty or keyword for your search below. A randomized clinical trial of intermittent subglottic secretion drainage in patients receiving mechanical ventilation. Reavy, K., & Tavernier, S. (2008, April). Monitor and verify ventilator settings every two (2) hours and as needed.Assure that ventilator alarm volumes are audible at all times. Two more teaching sessions will be provided on May 23, 2010 from 11 a.m. to 12 noon and from 10 p.m. to 11 p.m. Six brochures to notify staff of the in-service dates and times will be prepared and placed in the restrooms, break rooms and in hallways within the unit (Appendix D). J.If the patient exhibits signs/symptoms of respiratory distress or ventilator alarm sounds and problem cannot be quickly identified, disconnect patient from the ventilator, manually ventilate, and call for appropriate assistance. Wash hands with antiseptic soap and water or apply alcohol-based hand gel before and after performing interventions. Studies by DeRiso et al. Tsai et al.’s study has patient heterogeneity (of both medical and surgical ICU patients) which may have confounded the results. DeRiso, A. Ladowski, J.Dillon, T. Justice, J.Peterson, A. Randomized surgical patients undergoing heart surgery. If you are attempting to submit your project report to ValpoScholar, please send your materials to scholar@valpo.edu. If you are looking for help with your studies, we offer a a range of services provided by fully qualified academics in your field of study. 2009). We plan to implement the change at Scottsdale Healthcare Shea medical surgical ICU from June 1, 2010 to April 1, 2011. L.Weaning – Follow specific weaning/extubation orders per respiratory protocol or as written by the physician. Numerous risks factors contribute to the development of ventilator-acquired pneumonia as mechanical ventilation presents a unique set of challenges for the patient requiring intubation and ventilator support. CHEST, 121, 858-862. In ICU, the staff will be prepared for the change by explaining them the magnitude of the problem, so that they feel the need for the change. Another related intervention assessed in a similar randomized clinical study was the use of subglottal suctioning by Smulders et al. All the nurses at Scottsdale Healthcare ICUs will need to be reached to ensure that everyone can benefit from this information. They will be notified about the statistics of VAP prevalence and the magnitude of the complications of VAP. duration and 20 sec. Presented by: Cathleen Johannes Sarah Lipka Nicole Scott … A quality improvement project was initiated to avoid delays in care for patients with hand trauma Step 2. Review of Evidence and Synthesis of Literature. Rigorous clinical studies show oral secretions pose an increased risk for developing VAP (Augustyn, 2007). Knowing the researcher’s expectations, this could “become part of the treatment construct that is being tested” (Polit and Beck, 2008, p. 301). This provides evidence for the need to implement such an intervention and continue research. Education for new changes to protocols is usually brief, and like any change, will take some time for the staff to acclimate to. This information on VAP rates and patient length of stay after implementing the new interventions would be put together and submitted to the appropriate committees. The last thing a patient wants when going to a hospital for treatment is a hospital-acquired infection. The work environment healthcare professionals face daily is demanding.Nurses manage heavy workloads and high acuity patients along with staffing shortages and cost cuts, which reduce all available resources.This creates challenges to implementing new policies, protocols, or evidence-based practice (EBP).Some of the potential barriers to implementing EBP clinical changes can be categorized as individual, organizational, environmental, and communication based barriers (Udod & Care, 2006).Although it appears to be an impossible task, there are many strategies to help gain cooperation from the individuals responsible for implementing change.A few strategies are managerial support, clearly written research, exposure to real-life case studies, role modeling, staff engagement opportunities, and psychosocial support (Udod & Care; Thompson, Bell & Prevost, 1999). Contact us or find a patient care location. Retrieved April 10, 2010, from http://wilderdom.com/theory/UnfreezeCgangeRefreeze.html. The solution proposed was to include an electronic device for bedside charting at the beds in the postpartum unit. Nurses and physicians cite the desire for clearly written research reports and exposure to case studies where EBP resulted in improved outcomes.Providing appropriate education and tools for EBP implementation and ensuring access to evidence will reinforce and help providers understand the benefits (Melnyk & Fineout-Overholt, 2005).Psychosocial support is an important strategy, which simply means nurses are enabled and encouraged to perform the desired change.This is accomplished with good education, clear-cut expectations, reinforcement, acknowledgement, and rewards.Another similar strategy is role modeling nursing practice.This is done by demonstrating commitment and supporting the cause for advancing the EBP, while performing or educating staff about the desired change. If the finding suggests a decrease in VAP rate during pilot project, the change will need to be implemented to other ICUs of Scottsdale Healthcare. Follow the Institute of Johns Hopkins Nursing on Twitter for the most current news and updates. Evidence based practice is “the key to delivering the highest quality of healthcare and ensuring the best patient outcomes at the lowest costs” (Melnyk & Fineout-Overholt, 2011). Training & Development, 61(11), 24-27. St. Louis, MO: Elsevier Saunders. For example, evidence-based practice informs the types of questions asked during the diagnostic procedures and might even impact the diagnosis itself (Bennett & … See below for definitions, PICO templates, and example questions from the primary clinical domains: intervention, diagnosis, etiology, prevention, prognosis/prediction, quality of life/meaning, and therapy. The authors propose to implement the pilot project initially in the ICU of Scottsdale Healthcare at Shea campus. Provide oral care every 2 hours with chlorhexidine rinse. Consider the clinical environment in which you are currently working or have recently worked. The use of an evidence-based practice (EBP) alternative to seclusion is to ensure consistency in nursing practice, policies and procedures, and to promote safety and quality of care for PLWMHDs. The registered nurses will implement the learned techniques of using chlorhexidine in oral care and suction patients prior to position change every two hours and as needed for the duration of plot project from June 1, 2010 to April 1, 2011. This study would also require a qualified personal to educate the staff on the protocol changes and be available to answer any questions which may arise. Is free nurses to attend one of the medical Sciences, 336, 397-401. doi:10.1097/MAJ.0b013e31816b8761 patients during daily multidisciplinary vent... Four ( 4 ), endotracheal intubation ( EI ) and mechanical ventilation save money for the need be... 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