American Association of Critical-Care Nurses (2010). - Weebly



Project Scope and PlanJulie IveyFerris State UniversityAbstractThis document describes in detail the project Oral Care Protocol for Mechanically Ventilated Patients. The author discusses the project, the goal for the project, its purpose and importance in the intensive care unit, and how it will improve health care outcomes. Intensive care nurses must provide oral care to mechanically ventilated patients to assist with the prevention of ventilator-associated pneumonia. The oral care protocol will be guided by the American Association of Critical-Care Nurses' guidelines for oral care on mechanically ventilated patients. The team multidisciplinary team members are the project manager, nurse manager, nurse educator, experienced RN, and experienced respiratory therapist. The timeline, objectives and tasks were created by the project manager and thoroughly discussed in this document. The author describes how current research and literature correlate with the Oral Care Protocol for Mechanically Ventilated Patients. Current research states that ventilator-associated pneumonia is linked to poor oral hygiene. Project Scope and PlanIn a hospital I worked at as an ICU (intensive care unit) nurse, I have found that many of the nursing staff are new nurses or come from a floor where they never cared for mechanically ventilated patients. Many of the new nursing staff was unclear of what to do regarding oral care on a mechanically ventilated patient because the intensive care units do not have a specific protocol for providing oral care. The nursing staff may not understand the importance of oral care for mechanically ventilated patients. According to new research, "there is substantial lack of knowledge among ICU professionals on VAP prevention" (Viana, Bragazzi, Couto de Castro, Alves, Rocco, 2013, p. 308). When patients are mechanically ventilated, they are at an increased risk of developing pneumonia. Oral care decreases the risk of ventilator-associated pneumonia (VAP) in these patients. A study by Viana, Bragazzi, Couto de Castro, Alves, and Rocco (2013), was conducted at an intensive care unit in Brazil to decrease ventilator-associated pneumonia in mechanically ventilated patients. They found that with education, a bundle checklist, and standard oral care, there was a reduction in VAP rates (Viana, Bragazzi, Couto de Castro, Alves, Rocco, 2013). The project I will be undertaking is an Oral Care Protocol for Mechanically Ventilated Patients.There is no specific place to document the oral care that is provided for mechanically ventilated patients in the ICU I worked in except in the nursing notes. It goes to say in nursing that if it is not documented it did not occur. I plan to provide an in-service on the importance of oral care and implement guidelines recommended by the American Association of Critical-Care Nurses (AACN) for the ICU nurses to follow when providing oral care. The documentation will also correlate with the new oral care protocol. The protocol will assist nurses to understand how to assess the patient's oral cavity and lungs and what to look for when providing oral care. Use of an oral care protocol reduces oral inflammation and improves oral health (AACN, 2010, p. 5).The AACN (2010) recommends the nurse to brush the patient's teeth at least twice a day and use oral chlorhexidine gluconate (0.12%) rinse twice a day for adult cardiac surgery patients. According to the AACN (2010), "colonization of the oropharynx contributes to VAP" and "growth of pathogenic bacteria in dental plaque provides a breeding ground for microorganisms that produce VAP" (p. 5). It is also recommended by the AACN to moisten the mouth every two to four hours with a mouth sponge and apply lip moistener to prevent cracks and dry lips as needed.The project will entail creating a protocol for providing oral care to a mechanically ventilated patient and a specific area to document the procedure. The protocol is needed to assist the ICU nurses in providing safe quality care to mechanically ventilated patients. Protocols are written instructions for nurses to follow when patients have specific problems from a health concern that usually has a predictable outcome ("Protocols and Guidelines", 2008). The oral care protocol will be detailed and provide the nurse with the steps to take when caring for a mechanically ventilated patient as well as what to look for when assessing the oral cavity and lungs. The new documentation will also help nurses remember to provide oral care and gives a specific area to document the oral care that is provided. Project GoalThe goal of the project is to increase the knowledge of the nurses about the importance of oral care on mechanically ventilated patients by September 23, 2013. A pre and post test will be given at the oral care in-service and nurses will score an 80% or higher on the post test. Another goal for the project is for an increase in quality of care for mechanically ventilated patients as evidence by 100% adherence to the oral care protocol by November 29, 2013. Documentation for the oral care protocol will be reviewed weekly to ensure 100% adherence to the oral care protocol by November 29, 2013. A long term goal I would like to implement in the future, beyond this class, is to eventually have a decrease in noscomial infections related to mechanical ventilation. Importance of Project The importance of this project will reflect the new and seasoned nurse's greater understanding of how to safely care for mechanically ventilated patients. The protocol will decrease stress in new nurses learning the new ICU position and caring for mechanically ventilated patients they are unfamiliar with and have not cared for in the past. Intensive care unit nurses will have an increased knowledge of the importance of oral care and what to look for when assessing the oral cavity and lungs, which can prevent noscomial infections such as pneumonia. Another reason this project is important is to decrease the risk of ventilator-associated pneumonia in mechanically ventilated patients. Providing an oral care protocol will assist nurses in providing quality care to these patients. In a study to determine the effects of systematic oral care in intubated children, Ames, Sulima, Yates, MucCullagh, Gollins, Soeken, and Wallen (2013) found that "Oral assessment scores improved after nurses implemented a protocol for systematic oral care" (p. 103 ). Ventilator-associated pneumonia is an important cause of mortality and morbidity. "Strategies aimed at reducing the incidence of this complication may improve clinical outcomes, minimize costs related to health care, and foster patient safety" (Viana, Bragazzi, Couto de Castro, Alves, Rocco, 2013, p. 308).Improving Health Care OutcomesOral care is important and often overlooked with mechanically ventilated patients in the intensive care unit. Oral care provides comfort to the patient, keeps the mouth moist, decreases organism growth, decreases dry cracked mucus membranes, and decreases the risk of ventilator-associated pneumonia. Nurses caring for mechanically ventilated patients need to understand why oral care is important, have protocols to go by when providing oral care, and also document the oral care that is provided. By providing oral care to the mechanically ventilated patient, the nurse can prevent an increased length of hospital stay due to ventilator-associated pneumonia (Viana, Bragazzi, Couto de Castro, Alves, Rocco, 2013, p. 309). There will also be a decrease in the mortality associated with VAP. In a recent study on chlorhexidine, it was found that, "Oral rinse reduced respiratory infections in cardiac surgery patients" and "reduced nosocomial pneumonia in patients intubated >24 hours" (AACN, 2010, p. 6). According to QSEN (2012), nurses must be competent in minimizing the risk of harm to patients through system effectiveness and individual performance such as following a protocol. Team MembersI spoke to the ICU nurse manager and some of the ICU nurses (new and seasoned) about the unit not having an oral care protocol for mechanically ventilated patients and they all agree that creating and implementing a protocol would be beneficial to the nursing staff and patients. I also spoke with the ICU nurse educator about the project and she believes an oral care protocol is important for new nurses as well as seasoned nurses. This project will be for the intensive care unit. The ICU nurses will be the focus of the project and increasing their knowledge of oral care. I plan to have the ICU nurse manager, new and seasoned ICU nurses, an ICU nurse preceptor, and ICU nurse educator working alongside me to review the best evidence-based research to create an oral care protocol with documentation for mechanically ventilated patients. I will be the project manager and oversee and lead the project. According to Yoder-Wise (2011) a leader must maintain balance, generate self-motivation, build self-confidence, listen to his or her "followers", and have a positive attitude. Supporting LiteratureBy creating a standardized protocol and documentation for providing oral care for mechanically ventilated patients it will, promote patient safety which will ultimately improve patient outcomes. Mechanically ventilated patients are at highest risk for pneumonia. In a study regarding implementing a standardized oral care protocol for mechanically ventilated patients, Schleder, Stott, and Lloyd (2002) found that, "the preliminary data suggest that the mere reduction of risk through better oral hygiene can lead to fewer VAPs" (p. 30). According to Nursing: Scope and Standards of Practice (2010), "The registered nurse acquires knowledge and skills appropriate to the role, population, specialty, setting, role, or situation" (ANA, p. 49). By incorporating evidence based research into practice, new nurses to the unit will gain knowledge needed to care for mechanically ventilated patients. According to Blot, Vandijck, and Labeau (2008), "Good oral hygiene is a key issue in preventing dental plaque formation and microbial growth in the mouth" (p. 153). Nurses in my unit often over look oral care due to lack of knowledge regarding the importance of oral care and no specific area to document the procedure. The lack of area to document the oral care may also cause the nurse to forget to provide oral care. A protocol for oral care will assist the ICU nurses in providing safe effective care the patient deserves. "Only adequately explicit protocols contain enough detail to lead different clinicians to the same decision when faced with the same clinical scenario" (Morris, 2003, p. 236)."A recent meta-analysis suggests that oral care is significantly associated with reduced VAP rates" (Feider, Mitchell, and Bridges, 2010, p. 181). Providing oral care can decrease these risks. There needs to be increased education along with specific documentation and guidelines for oral care on mechanically ventilated patients for all ICU nurses to follow in my unit. A study by Feider, Mitchell, and Bridges (2010) found that, "A gap exists between national oral care standards, reported oral care practices, and unit-level oral care policies. Therefore, our study results suggest that current oral care practices do not match evidence-based recommendations" (p. 182). My unit does not have a specific protocol for oral care and I would like to implement one along with documentation to hopefully close the gap between national standards and actual unit policies and practices. Project Objectives/Deliverables These objectives were created to ensure the goals of the project will be achieved. They are specific and help paint a mental picture of the whole project. The objectives/deliverables can also be seen in Appendix A.1. Meet with team members and review current situation by June 20, 2013.2. Contact other surrounding hospitals to determine their current protocol by June 24, 2013.3. Review current research on oral care and discuss findings with team by June 28, 2013.4. Create rough draft of protocol by August 1, 2013.5. Interview staff about perception of protocol by August 13, 2013. 6. Create new documentation by August 21, 2013. 7. Revise protocol and documentation by August 23, 2013. 8. Meet with team to discuss and review in-service plan by September 6, 2013.9. Make any necessary changes and print by September 11, 2013.10. In-service of new protocol and documentation with team and ICU staff by September 23, 2013. 11. Review comments and pre and post tests by October 8, 2013.12. Implement oral care protocol and documentation by October 23, 2013. 13. 100% staff adherence to protocol by November 29, prehensive List of Project Requirements/Activities/Tasks The project requirements, activities, and tasks are detailed with a time frame attached. These project requirements, activities, and tasks will assist with achieving the objective, which in turn will achieve the goals of the project. This list is also in Appendix A. A calendar of the project is available in Appendix B. The calendar provides a visual of the project and will help the team stay on task. I use calendars for school and work and have found it works well in keeping me organized; I believe it will help with this project as well. 1. Meet with team members and review current situation by June 20, 2013.1.1 Meet with nurse manager for initial discussion and advice/recommendations on protocol by June 13, 2013.1.2 Identify team members who will be beneficial to the team and project by June 17, 2013.1.3 Meet with selected team members and discuss the project by June 20, 2013.2. Contact other surrounding hospitals to determine their current protocol and documentation by June 24, 2013.2.1 Get list and numbers of hospitals in area by June 21, 2013.2.2 Go to area hospital ICUs and get copies of oral care protocol and documentation if available by June 24, 2013.3. Review current research on oral care and discuss findings with team by June 28, 2013.3.1 Review evidence-based research and current oral care protocols by June 26, 2013.3.2 Determine what information is pertinent by June 27, 2013. 3.3 Meet with team and discuss findings by June 28, 2013. 4. Rough draft of protocol complete and signed by all members by August 1, 2013.4.1 All members write about thoughts on protocol and present to team members by July 1, 2013. 4.2 Review ideas from team members by July 8, 2013. 4.3 Develop a plan of action by July 17, 2013. 4.4 Create rough draft of protocol and present to team members by July 26, 2013.4.5 Review final draft of protocol by project manager by August 1, 2013.5. Interview staff about perception of protocol by August 13, 2013.5.1 Create survey to interview staff to determine perceptions and willingness to change to a new oral care protocol by August 5, 2013. 5.2 Interview staff by August 7, 2013. 5.3 Review results of staff interviews by August 12, 2013. 5.4 Present results to team members and discuss by August 13, 2013.6. Create new documentation by August 21, 2013.6.1 Review current documentation for oral care by August 14, 2013.6.2 Determine best documentation that follows oral care protocol by August 16, 2013. 6.3 Draft of documentation presented to team members by August 19, 2013.6.4 Final draft of documentation for oral care signed by all members by August 21, 2013.7. Revise protocol and documentation by August 23, 2013.7.1 Revise protocol and documentation as needed by August 22, 2013.7.2 Have copies made for all ICUs and in-service by August 23, 2013.8. Meet with team to discuss and review protocol, documentation, and in-service plan by September 6, 2013.8.1 Review literature regarding importance of oral care for mechanically ventilated patients by August 26, 2013.8.2 Present literature findings to team members and create a format for in-service by August 28, 2013.8.3 Determine team members who will be presenting the protocol, documentation, and literature review in the in-service by August 28, 2013. 8.4 Create a pre and post test for in-service by August 30, 2013.8.5 Present pre and post test to team and revise as needed by September 2, 2013.8.6 Discuss the flow of the in-service with all team members and go through a practice in-service by September 6, 2013.9. Review and make any necessary changes to all documents and print by September 11, 2013.9.1 Meet with all team members to review and make changes to the protocol, documentation, pre and post test, and in-service format by September 9, 2013.9.2 Make flyers of in-service by September 10, 2013.9.3 Make copies of final drafts of each document by September 11, 2013.10. In service of new protocol and documentation with team and ICU staff by September 23, 2013. 10.1 Send out an email to all ICU staff regarding time, date, and location of the mandatory oral care in-service by September 12, 2013.10.2 Send out in-service flyers to all ICUs and break rooms by Septembers 12, 2013. 10.3 Set up the room where the in-service will be held by September 22, 2013.10.4 Present the protocol, documentation and literature review to the ICU staff in the in-service by September 23, 2013. 11. Review comments and pre and post tests by October 8, 2013.11.1 Ensure all staff attended by having everyone sign in and complete a pre and post test by September 23, 2013.11.2 Present pre and post results to team members by September 27, 2013.11.3 Review and determine if more teaching is needed for ICU staff by October 8, 2013. 12. Implement oral care protocol and documentation by October 23, 2013.12.1 Implement the oral care protocol and ensure protocol and documentation are in each ICU by October 23, 2013.12.2 Review documentation weekly to ensure protocol is followed from October 23, 2013 to November 29, 2013.13. 100% staff adherence to protocol by November 29, 2013.Timeline A timeline is important to keep the project contained so team members are not continuously adding things that are not necessary to achieve the goals. The timeline is also shown in Appendix A in full detail. Objective 1: June 20, 2013Total 9 hours1.1 June 13, 20133 hours1.2 June 17, 20132 hours1.3 June 20, 20134 hoursObjective 2: June 24, 2013Total 8 hours2.1 June 21, 20132 hours2.2 June 24, 20136 hoursObjective 3 June 28, 2013Total 16 hours3.1 June 26, 20138 hours3.2 June 27, 20134 hours3.3 June 28, 20134 hoursObjective 4 August 1, 2013Total 32 hours4.1 July 1, 20135 hours4.2 July 8, 20138 hours4.3 July 17, 20136 hours4.4 July 26, 201310 hours4.5 August 1, 20133 hoursObjective 5: August 13, 2013Total 25 hours5.1 August 5, 20133 hours5.2 August 7, 201310 hours5.3 August 12, 20139 hours5.4 August 13, 20133 hoursObjective 6 August 21, 2013Total 11 hours6.1 August 14, 20131 hour6.2 August 16, 20132 hours6.3 August 19, 20135 hours6.4 August 21, 20133 hoursObjective 7 August 23, 2013Total 3 hours7.1 August 22, 20132 hours7.2 August 23, 20131 hourObjective 8 September 6, 2013Total 24 hours8.1 August 26, 20136 hours8.2 August 28, 20135 hours8.3 August 28, 20131 hour8.4 August 30, 20136 hours8.5 September 2, 20133 hours8.6 September 6, 20133 hoursObjective 9 September 11, 2013Total 5 hours9.1 September 9, 20133 hours9.2 September 10, 20131 hour9.3 September 11, 20131 hourObjective 10 September 23, 2013Total 4 hours10.1 September 12, 20131 hour10.2 September 12, 20131 hour10.3 September 22, 20131 hour10.4 September 23, 20131 hourObjective 11 October 8, 2013 Total 10 hours11.1 September 23, 20131 hour11.2 September 27, 20135 hours11.3 October 8, 2013, 4 hoursObjective 12 October 23, 2013Total 22 hours12.1 October 23, 20132 hours12.2 October 23-November 29, 201320 hoursObjective 13 November 29, 2013Total 2 hoursAssumptions & Constraints Assumptions are what is thought to happen with no problems in a project. "Assumptions presume that what you're planning or relying on is true, real, or certain" (Heldman, 2011, p. 94). Assumptions are helpful for thinking of what is intended and attempting to sway the project in a way that will closely resemble the assumptions. I plan to celebrate when the in-service is finished, and when the adherence to the protocol is 100%. I have thought of a few assumptions for this project to guide the project in the right direction. The first assumption is that everything will go smoothly and there will not be any problems in the project. The second assumption is that the team will be able to meet at all desired times for the project. This is a desired assumption and with planning may occur. The third assumption is that all team members will communicate in a respectful timely manner throughout the project. By setting rules from the beginning, this should not be much of a problem. The fourth assumption is that the timelines will be realistic and accurate. This assumption has been reviewed and there are small gaps in the timeline so that it is realistic and functional for the whole team. The fifth assumption is that minimum changes will be necessary to for the protocol and documentation. The sixth assumption is that the desired outcomes are attainable. With proper planning, this assumption is feasible.Constraints are things that will hold up the project and may even cause the project to not reach its goals or finished state. "Constraints, like assumptions, are also documented in the project scope statement" (Heldman, 2011, p. 96). Constraints need to be thought about when developing a project to better plan for some of these issues and work on them before they become a problem. There are six constraints for this project that will be discussed. I plan to manage these constraints by preparing for them ahead of time. The first constraint is the resistance to change by seasoned nurses and other staff. With proper education this constraint may not be an issue. The second constraint is the different levels of learning abilities in nurses. With a survey of how the nursing staff learns best, their view of the project, and their thoughts toward change, this constraint can be minimized. The third constraint is that the nurse manager and coworker may have prior obligations and a full time schedule that limits their accessibility to the project and meeting times. This constraint has been well thought of and planned for. There are gaps in the timeline to allow for changes in meeting times, cancellations of meetings, and things that come up with the team members of the project. Some of the things on the timeline may get done faster than anticipated, leaving extra time for the unexpected. The fourth constraint is that numerous changes to the protocol and documentation will impede progress in the project. There are most likely going to be changes to the project and documentation and the gaps in the timeline will assist with keeping things on target. The sixth constraint is that the information may be too overwhelming for new nurses to take in. Determining what the nurses already know with the pre test will assist with determining if learning occurred when the post test is given. Allowing the nursing staff to ask questions and voice concerns during the in-service will decrease the stress of learning something new.Success CriteriaThis project will provide nurses with the information needed to care for mechanically ventilated patients. New nurses can be stressed with learning the new position and having an oral care protocol will give guidance to these nurses and assist them with decisions about oral care assessments. To measure the success of this project, nurse's knowledge will be increased as evidence by a post test score of 80% or higher by September 23, 2013. Pre and post test score will be compared. This project is important to nurses and patients in the ICU because there needs to be consistency of care and patients deserve quality and the best possible care while in the hospital. Another way success of this project will be measured is by 100% adherence to the protocol. Oral care can decrease the risk of pneumonia and provide comfort to patients who are mechanically ventilated. Ventilator-associated pneumonia is the most common infection found in critically ill mechanically ventilated patients. "The incidence of VAP ranges from 10% to 30% with a crude mortality that may exceed 50% and is associated with increased prolonged intensive care and hospital stay, increased cost and delays in recovery" (Andrews, Steen, 2013, p. 116). By decreasing the risk of pneumonia, the patient will have a decreased hospital stay and decreased complications related to pneumonia. Providing adequate oral care to the ventilated patient can decrease the risk of VAP. According to Feider, Mitchell, and Bridges (2010), "Ventilator-associated pneumonia (VAP) is a major threat to patients who are receiving mechanical ventilation. Oral care is a nursing intervention that decreases the incidence of VAP" (p. 176). A study by Scannapieco et al. (2003) examined the association between oral disease and bacterial pneumonia in patients with chronic lung disease and intensive care patients (Andrews, Steen, 2013). They found that the development of ventilator-associated pneumonia was linked to poor oral hygiene (Andrews, Steen, 2013).ReferencesAmerican Association of Colleges of Nursing (2012). Graduate-level QSEN competencies knowledge, skills, and attitudes. Retrieved from Association of Critical-Care Nurses (2010). Oral care for patients at risk for ventilator-associated pneumonia. Retrieved from Nurses Association (2010). Nursing scope and standards of practice (2nd Ed.). Silver Spring, MD: Author Ames, N.J., Sulima, P., Yates, J.M., McCullagh, L., Gollins, S.L., Soeken, K., Wallen, G.R. (2011). Effects of systematic oral care in critically ill patients: A multicenter study. American Journal of Critical-Care Nurses 20(5): 103-114 doi:10.4037/ajcc2011359Andrews, T., Steen, C. (2013). A review of oral preventative strategies to reduce ventilator-associated pneumonia. Nursing in Critical Care 18(3):116-122 doi:?10.1111/nicc.12002Blot, S., Vandijck, D., Labeau, S. (2008). Oral care of intubated patients. Clinical Pulmonary Medicine 15(3):153-160 doi: 10.1097/CPM.0b013e3181729250?Developmental disabilities nursing manual companion guide: Protocols and guidelines (2008). Retrieved from , L.L., Mitchell, P., Bridges, E. (2010). Oral care practices for orally intubated critically ill adults. American Journal of Critical Care 19(2):175-183 doi: 10.4037/ajcc2010816Heldman, K. (2011). Project Management jump start (3rd ed.). Indianapolis, Indiana: Wiley Morris, A.H. (2003). Treatment algorithms and protocolized care. Current Opinion in Critical Care 9: 236-240. Salt Lake City, UT: Lippincott Williams & WilkinsSchleder, B., Stott, K., Lloyd, R.C. (2002). The effect of a comprehensive oral care protocol on patients at risk for ventilator-associated pneumonia. Journal of Advocate Health Care 4(1): 27-30Viana, W.N., Bragazzi, C., Couto de Castro, J.E., Alves, M.B., Rocco, J.R. (2013). Ventilator-associated pneumonia prevention by education and two combined bedside strategies. International Journal for Quality in Health Care 25(3): 308-313 doi:10.1093/intqhc/mzt025Yoder-Wise, P.S. (2011). Leading and managing in nursing (5th ed.). St. Louis, MO: Elsevier MosbyAppendix AProject Timeline and ScheduleObjectiveExpected Completion DateActual Completion DateProjected HoursActual Hours1. Meet with team members and review current situation by June 20, 2013.1.1 Meet with nurse manager for initial discussion and advice/recommendations on protocol by June 13, 2013.1.2 Identify team members who will be beneficial to the team and project by June 17, 2013.1.3 Meet with selected team members and discuss the project by June 20, 2013.6/136/176/203242. Contact other surrounding hospitals to determine their current protocol and documentation by June 24, 2013.2.1 Get list and numbers of hospitals in area by June 21, 2013.2.2 Go to area hospital ICUs and get copies of oral care protocol and documentation if available by June 24, 2013.6/216/2426 3. Review current research on oral care and discuss findings with team by June 28, 2013.3.1 Review evidence-based research and current oral care protocols by June 26, 2013.3.2 Determine what information is pertinent by June 27, 2013. 3.3 Meet with team and discuss findings by June 28, 2013. 6/266/276/288444. Rough draft of protocol complete and signed by all members by August 1, 2013.4.1 All member write about thoughts on protocol and present to team members by July 1, 2013. 4.2 Review ideas from team members by July 8, 2013. 4.3 Develop a plan of action by July 17, 2013. 4.4 Create rough draft of protocol and present to team members by July 26, 2013.4.5 Review final draft of protocol by project manager by August 1, 2013.7/17/87/177/268/15861035. Interview staff about perception of protocol by August 13, 2013.5.1 Create survey to interview staff to determine perceptions and willingness to change to a new oral care protocol by August 5, 2013. 5.2 Interview staff by August 7, 2013. 5.3 Review results of staff interviews by August 12, 2013. 5.4 Present results to team members and discuss by August 13, 2013.8/58/78/138/13310936. Create new documentation by August 21, 2013.6.1 Review current documentation for oral care by August 14, 2013.6.2 Determine best documentation that follows oral care protocol by August 16, 2013. 6.3 Draft of documentation presented to team members by August 19, 2013.6.4 Final draft of documentation for oral care signed by all members by August 21, 2013.8/148/168/198/2112537. Revise protocol and documentation by August 23, 2013.7.1 Revise protocol and documentation as needed by August 22, 2013.7.2 Have copies made for all ICUs and in-service by August 23, 2013.8/228/23218. Meet with team to discuss and review protocol, documentation, and in-service plan by September 6, 2013.8.1 Review literature regarding importance of oral care for mechanically ventilated patients by August 26, 2013.8.2 Present literature findings to team members and create a format for in-service by August 28, 2013.8.3 Determine team members who will be presenting the protocol, documentation, and literature review by August 28, 2013. 8.4 Create a pre and post test for in-service by August 30, 2013.8.5 Present pre and post test to team and revise as needed by September 2, 2013.8.6 Discuss the flow of the in-service with all team members and go through a practice in-service by September 6, 2013.8/268/288/288/309/29/66516339. Review and make any necessary changes to all documents and print by September 11, 2013.9.1 Meet with all team members to review and make changes to the protocol, documentation, pre and post test, and in-service format by September 9, 2013.9.2 Make flyers of in-service by September 10, 2013.9.3 Make copies of final drafts of each document by September 11, 2013.9/99/109/1131110. In service of new protocol and documentation with team and ICU staff by September 23, 2013. 10.1 Send out an email to all ICU staff regarding time, date, and location of the mandatory oral care in-service by September 12, 2013.10.2 Send out in-service flyers to all ICUs and break rooms by Septembers 12, 2013. 10.3 Set up the room where the in-service will be held by September 22, 2013.10.4 Present the protocol, documentation and literature review to the ICU staff in the in-service by September 23, 2013. 9/129/129/229/23111111. Review comments and pre and post tests by October 8, 2013.11.1 Ensure all staff attended by having everyone sign in and complete a pre and post test by September 23, 2013.11.2 Present pre and post results to team members by September 27, 2013.11.3 Review and determine if more teaching is needed for ICU staff by October 8, 2013. 9/239/2710/815412. Implement oral care protocol and documentation by October 23, 2013.12.1 Implement the oral care protocol and ensure protocol and documentation are in each ICU by October 23, 2013.12.2 Review documentation weekly to ensure protocol is followed from October 23, 2013 to November 29, 2013. 10/23 10/23-11/29 2 2013. 100% staff adherence to protocol by November 29, 2013. 11/29 2Appendix BCalendar of projectJuneSundayMondayTuesdayWednesdayThursdayFridaySaturday1. 2.3.4.5.6.7.8.9.10.11.12.13. Meet with nurse Manager14.15.16.17.Determine team members18.19.20. Meet with team21. Hospital List22.23.24. Get protocols from area hospitals25.26. Gather evidence-based reseaerch27. Determine pertinent info28. Team Meeting29.30JulySundayMondayTuesdayWednesdayThursdayFridaySaturday1. Team meeting on protocol thoughts2.3.4.5. 6. 7.8. Review ideas9.10.11.12.13.14.15.16. 17. Develop plan of action18.19.20.21.22.23.24.25.26. Rough draft of protocol, team meeting27.28.29.30.31AugustSundayMondayTuesdayWednesdayThursdayFridaySaturday1. Final draft of protocol2.3.4.5. Create survey6.7. Interview staff8.9.10.11.12.13. Review results of survey14. Review current document-ation 15. 16. Determine best document-ation 17.18.19. Team meeting, draft of document-ation20.21. Final draft signed by all members22. Revise protocol and document-ation as needed23. Make copies for ICU24.25.26. Review literature on VAP27.28. Team meeting, discuss findings and inservice29.30. Create pre and post test31SeptemberSundayMondayTuesdayWednesdayThursdayFridaySaturday1.2. Team meeting on pre and post test3.4.5.6. Team meeting, discuss inservice7.8.9. Team meeting to make changes to any documents10. Make flyers for in-service11. Make copies of final drafts of all documents12. Send email to staff. Send out flyers13.14.15.16.17.18.19.20.21.22. Set up in-service room23. In-service of protocol, sign in sheet24.25.26.27. Team meeting on pre and post test results28.29.30.OctoberSundayMondayTuesdayWednesdayThursdayFridaySaturday1.2.3.4.5.6.7.8. Determine if more teaching is needed9.10.11.12.13.14.15.16.17.18.19.20.21.22.23. Implement oral care protocol24.25.26.27.28.29.30. Review document-ation31.NovemberSundayMondayTuesdayWednesdayThursdayFridaySaturday1.2.3.4.5.6. Review document-ation7.8.9.10.11.12.13. Review document-ation14.15.16.17.18.19.20. Review document-ation21.22.23.24.25.26.27. Review document-ation28.29. 100% staff adherence!!30 ................
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