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Genigraphics® has been producing output from PowerPoint® longer than anyone in the industry; dating back to when we helped Microsoft® design the PowerPoint® software. US and Canada: 1-800-790-4001 Email: info@genigraphics.com [This sidebar area does not print.] EBP Project for Ventilator Associated Pneumonia Nicole Rea RNBC Online RN-BSN Program: NUR 415 University of Concordia, Seward Nebraska INTRODUCTIONIMPLEMENTATION PLANProposed VAP Change Project Centers For Disease Control: cdc.gov What is a Ventilator-Associated Pneumonia (VAP)? A “pneumonia” is an infection of the lungs. A “ventilator” is a machine that helps a patient breathe by giving oxygen through a tube. The tube can be placed in a patient’s mouth, nose, or through a hole in the front of the neck. The tube is connected to a ventilator. A “ventilator-associated pneumonia” or “VAP” is a lung infection or pneumonia that develops in a person who is on a ventilator. Why do patients need a ventilator? A patient may need a ventilator when he or she is very ill or during and after surgery. Ventilators can be life-saving, but they can also increase a patient’s chance of getting pneumonia by making it easier for germs to get into the patient’s lungs. What are some of the things that hospitals are doing to prevent ventilator-associated pneumonia? To prevent ventilator-associated pneumonia, doctors, nurses, and other healthcare providers: Keep the head of the patient’s bed raised between 30 and 45 degrees unless other medical conditions do not allow this to occur. Check the patient’s ability to breathe on his or her own every day so that the patient can be taken off of the ventilator as soon as possible. Clean their hands with soap and water or an alcohol-based hand rub before and after touching the patient or the ventilator. Clean the inside of the patient’s mouth on a regular basis. Clean or replace equipment between use on different patients. Keep the head of the patient s bed raised between 30 to 45 degrees. What can I do to help prevent VAP? If you smoke, quit. Patients who smoke get more infections. If you are going to have surgery and will need to be on a ventilator, talk to your doctor before your surgery about how you can quit smoking. Family members can ask about raising the head of the bed. Family members can ask when the patient will be allowed to try breathing on his or her own. Family members can ask doctors, nurses, and other healthcare providers to clean their hands. Family members can ask about how often healthcare providers clean the patient’s mouth. If you do not see your providers clean their hands, please ask them to do so. Can VAP be treated? VAP can be a very serious infection. Most of the time, these infections can be treated with antibiotics. The choice of antibiotics depends on which specific germs are causing the infection. Your healthcare provider will decide which antibiotic is best. EBP QUESTION REFERENCES CONTACT To improve patient outcomes, decrease cost and minimize length of stay for all patients on the ventilator there are a few small changes in daily nursing care that can be done. It has been shown that increasing the head of bed, oral hygiene can improve patient outcomes and decrease the risk of VAP. My proposed project will focus on these care changes as described below. The proposed practice change to prevent VAP would be to increase oral cares with chlorihexidine and head of bed elevation at all times at 35 degrees or higher. Prior to implementation education is crucial for all nursing and RT staff on our vent unit to ensure they understand the importance of these small changes. We would use our nurse educators to help complete this education and be sure that all staff understand how to complete the oral cares appropriately and timely as well as how to monitor the level of the head of bed to ensure it is at the right degree to prevent VAP. All physicians and patients and families would be educated on the changes and the reasons for changes and questions would be answered as needed. We would also have to use out purchasing department for a resource in obtaining the best and most cost effective oral suction catheters or yankauers, oral care packages/products. We will educate who is responsible to distributing and exchanging out products daily. We would educate and review the documentation needed to ensure that we can track that the care is being provided as intended. We would use our nurse educators and unit managers/supervisors to do random audits to be sure that the practices are being followed accurately and consistently. We would also use our medical director and infection control nurse to review all documented pneumonias on all vent patient before and after the implementation of practice changes to assess data and statistics later. If there is resistance from care givers we would work with them 1:1 or in small groups to find out why they are resisting and provide further EBP guidelines and education if needed. We would evaluate and assess their feedback as needed to ensure the success of this project as well. Can simple nursing interventions be used to prevent chronically/critically ill patients from ventilator associated pneumonia? P: chronically/critically ill patients hospitalized on ventilators I: Patients getting better oral care, head of bed elevation and prevention of peptic ulcer disease and deep vein thrombosis C: Ventilator bundle interventions versus standard of care intervention O: Improved patient outcomes with ventilator bundle interventions, decreased healthcare costs and decreased ventilator/hospital days. There are many stakeholders involved in VAP. Patients are directly influenced while the community, hospitals, government and healthcare in general are effecting by out consequences and substantial costs involved with caring for and treating patients with VAP. Ventilator associated pneumonia also known as Health-care Associated pneumonia (HCAP). VAP can be a very complicated and difficult to treat, and mentally/physically and emotionally draining for all involved. According to the CDC, “in 2002, an estimated 250,000 health-care associated pneumonias developed in US hospitals and 36,000 of these were associated with death. Patients with mechanically assisted ventilation have a high risk of developing VAP or HCAP.” www.cdc.gov 1. Center for Disease Control, www.cdc.govwww.cdc.gov 2. Narang, S. (2008). Use of ventilator bundle to prevent ventilator associated pneumonia. Oman Medical Journal, 23(2), 96-99. Retrieved from www.ncbi.nlm.nih.gov/pmc/articles/PMC328242 on 9-11-13. www.ncbi.nlm.nih.gov/pmc/articles/PMC328242 on 9-11-13 3. Schmidt, N & Brown, J. (2012). Evidence-Based Practice For Nurses 2 nd Edition. Jones and Bartlett Learning, LLC. Nicole Rea RNBC Concordia University Email: nicole.rea@cune.orgnicole.rea@cune.org Phone: 402-440-7936 Website: