Melanie Hardin-Pierce, RN, MSN, APRN-BC
Assistant Professor Acute Care Nursing Practitioner
Pamela Lawson, RN, MSN
Pulmonary Care Manager Critical Care Services
University of Kentucky Albert B. Chandler Medical Center
Purpose:
Adult ICU areas will have evidence-based nursing guidelines for care of mechanically ventilated patients and nursing staff will be aware of and accountable for maintaining these care activities.
Rationale:
There is a lack of guidelines incorporating evidence-based practice into the care of mechanically ventilated patients leading to a lack of standardization of care, and increased risks for ventilator-acquired pneumonia, increased length of stay, and increased number of days on the ventilator.
Synthesis of Evidence:
The incidence of nosocomial pneumonia is higher in intubated patients receiving mechanical ventilation and pneumonia is the second most common nosocomial infection in the United States. Current literature suggests that the aforementioned interventions when “bundled” together, lead to improved outcomes in mechanically ventilated patients, including decreased incidence of ventilator-acquired pneumonia. These interventions are both nursing and physician-driven, are economically feasible, and quantifiable.
Proposed Change in Practice:
Implementation of guidelines involving the following categories:
Deep Vein Thrombosis Prophylaxis, Peptic Ulcer Disease Prophylaxis, Sedation Protocol with daily “vacation” from sedation, Elevation of the Head of the Bed > Thirty Degrees, and Oral Care Guidelines
Implementation of Strategies:
- Creation of multidisciplinary evidence-based practice group with physician champion
- Development of protocols for deep vein thrombosis, peptic ulcer disease prophylaxis, sedation protocol with daily interruption of sedation, elevation of the head of the bed more than 30 degrees, and oral care guidelines
- Development of educational plan and timeline for implementation
- Execution of plan to introduce changes in clinical practice (involving all disciplines)
- Purchase of new oral care products based on evidence-based protocol
- Alter documentation forms to incorporate use of Riker Assessment Scale for sedation, and other clinical practice changes
- Evaluation of clinical practice and patient outcomes (involving all disciplines)
Evaluation:
- Critical care length of stay of mechanically ventilated patients
- Number of ventilator days for mechanically ventilated patients
- Mortality/morbidity data
- Incidence of ventilator-acquired pneumonia
Academic Center for Evidence-Based Nursing