Implementation of the VAP project is a significant step aimed at ensuring that the objectives of giving patients outmost care, improvement of nursing practices and achieving desirable patient’s outcomes on the mechanically ventilated patients in the critical care unit are realized. Nevertheless, there is the need for making sure that all the relevant implementation stages have been followed and adequately taken into consideration. This will ensure any possible hitches that may affect project execution along the way are equally addressed. Additionally, it will be imperative that well-informed decisions are made with the intentions of ensuring that all the steps in the implementation of VAP project are addressed and that there is no wastage of resources. Therefore, in order to have a clear framework for rolling out the VAP project, there is the need for approval from the organization’s management.
Question 1
The initial step towards realizing the goals of this undertaking is making sure that the approval from the management is given for the stakeholders responsible for carrying out the program can be able to proceed with their roles. Therefore, I will write a letter to the management requesting a meeting with them. This session will also feature other stakeholders in the hospital like physicians, nurses, physiotherapists and critical care unit specialists. The letter will be accompanied by a proposal that clearly outlines the statement of the problem and the budget allocation for all the activities that will be carried out. In the meeting, I will bring the management and the staff members up to speed concerning the need for operational changes on the management of VAP. The meeting will provide a sneak preview on the need for utilizing VAP bundles in addressing VAP and will be shown to be more helpful in comparison to the standard care practices which use antibiotics.
Question 2
It is imperative that critical care patients receive the best care for them to emerge with desirable outcomes which will not have a toll on their well-being in the long run. Patients in these healthcare units are usually under constant scrutiny for their good being, and if they are not provided with the required attention, the chances are that they will likely fall victims of VAP. This condition specifically affects patients that have been fitted with mechanical ventilators. It has been proven to be found in a quarter of all patients under mechanical ventilation (Bagi, 2015). These bacteria thrive in the lungs of a mechanically ventilated patient since they have got weak immune systems.
There is however concerns regarding the strategies that have been put in place to address this condition. The standard care which is aimed at restoring the health of these patients is not sufficient which calls for alternative means of addressing the problem. As such, it is imperative that proper critical care is provided to this portion of patients with the objectives of making sure that they come out of this hospital unit satisfied with the services that they have received. There is the need to shift the focus from standard care to the use of VAP prevention bundles which have been proven to be effective in addressing this problem satisfactorily. This realization has got the advantage of ensuring that the patients emerge with desirable outcomes.
Question 3
The use of sedatives is a major factor in the critical care unit directed at improving patient comfort, facilitate interventions, permit mechanical ventilation and decrease anxiety levels. Examples of sedatives that can be used include benzodiazepines, clonidine, and propofol. Sedation hold is important in preventing the patient from waking up due to agitation. Secondly, the performing a deep vein thrombosis prophylaxis is also a crucial step towards addressing the development of VAP in intubated patients. DVT Prophylaxis plays the role of reducing possible pulmonary embolism incidences (Rello et al., 2013). This regimen includes the use of mechanical methods like graduated compression socks or anticoagulants like weight heparin. The two prophylaxis measures are aimed at addressing any possible emergence of VAP incidences to the patient.
Thirdly, the use of stress ulcer prophylaxis has been proven to play a significant role in reducing the risk factors that have been associated with the development of VAP. The usage of Sucralfate has been shown to be effective in reducing gastric bleeding in mechanically ventilated patients which eventually translates to lowered incidences of the condition (Rello et al., 2013). In this direction, therefore, it is imperative that patients have a gradual reduction in ventilator support which is achieved through cutting back on the oxygen that they are supplemented with and eventually ending with tracheal de-canulation.
The fourth point concerning the use of VAP bundles is the prevention of pulmonary aspiration. As such, it is imperative that critical care nurses help patients in placing the head of their beds at an angle of between 30 degrees and 45 degrees. At this position, it becomes easy to prevent patients from inhaling oropharyngeal contents which eventually prevents any possible pulmonary aspiration incidences from occurring (Rello et al., 2013). Finally, proper oral hygiene is an essential step aimed at addressing VAP. Utilizing 0.12% chlorhexidine during the brushing of teeth has been to be an effective method of preventing cases of the condition. Proper rinsing of the mouth after a thorough cleaning session using the toothpaste has played a significant role in curbing the disease in mechanically ventilated patients.
Question 4
These VAP prevention bundles have been proven to be effective in controlling VAP incidences since they address the problems from the cause. By comparing these techniques to the standard care practices, there are many problems which are associated with the use of antibiotics in treating VAP. The comprehension that the bacteria responsible for VAP are constantly mutating may pose a threat on how to effectively address the problem since these pathogens will eventually become antibiotic resistant. As such, utilizing VAP bundles is the most efficient method of preventing the chances of this condition occurring in mechanically ventilated patients.
Question 5
A study done by Guterres et al (2012) shows that by critical care nurses making use of VAP bundles; the resultant effect have always led to desirable patient outcomes. By combining care with the aspiration of tracheal discharges, endotracheal cuff pressure ranging from 20 to 30 cm parts of water, headboard elevation of between 30 degrees to 45 degrees and oral hygiene involving 0.12% chlorhexidine, it eventually led to improvements in VAP rates. Another research done by Al-Thaqafy et al (2014) on the association between utilizing VAP bundles and the incidences of VAP showed that by effectively sticking to these practices, VAP rates reduced from 3.6 to 1 within a period of four years whereas the use of ventilators on such patients reduced to 0.59 from 0.73. These outcomes were as a result of a bundle compliance of 7%.
According to Nicolosi et al (2014), proper oral hygiene through the use of 0.12% chlorhexidine gluconate has got profound effects on addressing the problems brought about VAP. This study showed that patients who brushed their teeth with the toothpaste had shorter hospital stays compared to those who used traditional oral care techniques. Finally, Jansson et al (2013) posit that nurses have got limited knowledge concerning how to address adequately the challenges that are brought about by VAP condition. They proposed that critical care nurses need to be provided with the resources regarding skills, time, and guidance on how to utilize VAP bundles to reduce the rates of the condition amongst critically ill patients.
Question 6
The implementation process for this program will entail the integration of different stakeholders from the organization. Since many factors that need to be addressed in this situation, it is important that different professionals be involved in this process with the intention of coming up with a team that will satisfactorily address all the issues involved. As such, critical care nurses, nurse informaticists, an accountant, and physicians will be included in the process of overseeing these changes. To ensure that the project is a success and met with minimal resistance, there will be the need for incorporating hands-on experience training to all the stakeholders in the program. The training will be done in agreement with the organization’s mission, vision, and values which are important steps towards ensuring that the organization’s culture has been taken into consideration in the process. The nurse manager in charge of the critical care unit will be responsible for initiating change, overseeing the implementation process and making sure that workflow is maintained.
The nursing informaticists will be responsible for marinating patients’ records in an electronic manner. The accountant will play the role of budgeting and addressing the costs involved in the implementation process. Physicians will play the role of making sure that the correct medication measurements are adhered to. The role of staff education will be done by a critical care nurse who has got more than ten years experience in taking care of mechanically ventilated patients using VAP bundles. The education will be done by the use of pamphlets touching on areas concerning the working of the VAP bundles. The information contained in the pamphlet will include; daily sedation hold, the head of the bed to 30–45, deep vein thrombosis (DVT) prophylaxis, oral hygiene involving 0.12% chlorhexidine and gastric ulcer prophylaxis. Question 7
Resources required
Staff – Nurse Manager, 5 critical care nurses, 1 nurse informaticists, 1 accountant, 2 physicians.
This checklist will be maintained in an electronic format which will make it easier to make any corrections concerning the changes that will be occurring on the condition of patients. The documentation of patients’ information will be done on a weekly basis since this metrics will allow for a longer observational period. The nurse manager in charge of the critical care unit will be charged with making sure that the checklists are collected. The reviewing of the chart will be the responsibility of the key stakeholders in the program including the nurse manager, critical care nurses, the nurse informaticist and physicians. The responses from the chart information will be used to gauge the success rates of the program. This strategy will form the basis of the reviewing process.
Technology
The required technology for this program will be maintaining patients’ information in Electronic Health Record database by a nurse informaticist.
Funds
Budget
The nurse manager in charge of the critical care unit will be tasked with initiating, overseeing and the evaluation of the program.
References
Al-Thaqafy, M. S., El-Saed, A., Arabi, Y. M., & Balkhy, H. H. (2014). Association of compliance of ventilator bundle with incidence of ventilator-associated pneumonia and ventilator utilization among critical patients over 4 years. Annals of thoracic medicine, 9(4), 221.
Bagi, B. (2015, April). Ventilator-associated pneumonia in the ICU. in seventh annual spring scientific symposium in anesthesiology and intensive care (p. 88).
Guterres da Silva, S., Pereira do Nascimento, E. R., & Kuerten de Salles, R. (2012). Bundle to prevent ventilator-associated pneumonia: a collective construction. Texto & Contexto Enfermagem, 21(4).
Jansson, M., Ala-Kokko, T., Ylipalosaari, P., Syrjälä, H., & Kyngäs, H. (2013). Critical care nurses’ knowledge of, adherence to and barriers towards evidence-based guidelines for the prevention of ventilator-associated pneumonia–A survey study. Intensive and Critical Care Nursing, 29(4), 216-227.
Nicolosi, L. N., del Carmen Rubio, M., Martinez, C. D., González, N. N., & Cruz, M. E. (2014). Effect of oral hygiene and 0.12% chlorhexidine gluconate oral rinse in preventing ventilator-associated pneumonia after cardiovascular surgery. Respiratory care, 59(4), 504-509.
Rello, J., Afonso, E., Lisboa, T., Ricart, M., Balsera, B., Rovira, A., & Diaz, E. (2013). A care bundle approach for prevention of ventilator‐associated pneumonia. Clinical Microbiology and Infection, 19(4), 363-369.
