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Picot ProposalFion Kung, Student NurseUniversity of South FloridaUniversity of South Florida College of NursingNUR 4169C EBP for the RNPICOT Proposal FormType Information/Response in this Column Briefly describe the opportunity for clinical improvement.One of the most important hospital in the community is Florida Hospital of Tampa. After I worked on the ICU floor with different nurses, I noticed that oral care is not provided to the ICU patients at all. All the patients in the ICU are very sick, and I believe it is very important to raise awareness of the importance of oral care. Florida Hospital of Tampa should encourage and educate the nurses to implement good oral care to the patients. Good oral care can reduce chance of developing ventilator-associated pneumonia (VAP). Why is this issue important for your clinical setting or organization? There is no oral care guideline in my hospital. Poor or absence of the oral care for ICU patients have been noticed in my clinical site. According to CDC (2013), there was an about 250,000 healthcare-associated pneumonias developed in U.S. hospitals and 36,000 of the cases were associated with deaths. Poor or absence of oral care can increase the chance to develop infection such as ventilator-associated pneumonia. Ventilator-associated pneumonia is a serious complication that allows the bacteria into the lung, and it can cause some lung or immune problems. List 1-2 background pertinent questions. How does oral hygiene contribute to pneumonia?What can nurses do to implement good oral hygiene?What is currently being used/done at Florida Hospital of Tampa to prevent VAP? What is the policy on oral care in ICU? State the PICOT question.P In ICU patientsI ChlorhexidineC Sterile water O reduce ventilator-associated pneumoniaT during the hospitalized stayIn ICU patients, how does daily use of chlorhexidine compared to sterile water reduce ventilator-associated pneumonia during the hospitalized stay? Describe the ideas you have for solving the problem. The ideas that I have for solving the problem is to promote oral care, educate the nurses and staff about the importance of good oral care. I will educate and recommend the nurses and staff to use 0.12% chlorhexidine swab for the patients. What do you hope to achieve?I would like the nurse to implement good oral care to the patients. I would like to decrease the incidence of ventilator-associated pneumonia.How will you measure the outcome of your practice improvement?I will measure the outcome by evaluating how many patients have ventilator-associated pneumonia during their hospitalized stay . I also can look at the clinical pulmonary infection scores to evaluate the incidence of VAP in the chlorhexidine group versus the sterile water. Identify the members of your proposed project team by position or job title and their roles.Nurse Managers: Support of the oral care and agree with the budget to buy the chlorhexidine. Unit educator: Find the causes of the disease and educate the staff about the disease and the importance of good oral care. Charge nurse: Ensure the staff and faculties are implementing good oral care to the patients.Register nurses: Implement good oral care to the patients.Institution where the project might be implemented in the future.The project can be implemented in the hospitals, nursing home, long-term facilities, and assisted livings. List 3 peer reviewed research papers that will provide the evidence for the PICOTSee references belowReferences?z?aka, ?., Ba?o?lu, ?. K., Buduneli, N., Ta?bakan, M. S., Bacako?lu, F. & Kinane, D. F. (2012). Chlorhexidine decreases the risk of ventilator-associated pneumonia in intensive care unit patients: A randomized clinical trial. Journal of Periodontal Research, 47, 584–592. doi: 10.1111/j.1600-0765.2012.01470.xThe goal of this article is to determine if oral swabbing with 0.2% Chlorhexidine gluconate decreases the risk of ventilator-associated pneumonia in ICU patients. The criteria of patient population is mechanically ventilated or expected to be intubated for at least 48 hours after admission. In the study, there are 29 patients in the intervention group that use 0. 2% chlorhexidine gluconate to swab in the oral mucosa four times per day. On the other hand, the control group has 32 patients that only use saline. The strength of this article is that they used the randomized, double blind, controlled study method to divide patients into different groups. Without knowing the patients' background and disease can avoid any bias. However, the weakness of this article is the population is small, only sixty-one patients. It might not be as accurate. The relevance of source to nursing is high. The rational for inclusion in this proposal is that it shows the benefit of using 0.2% chlorhexidine reduce the risk of ventilator-associated pneumonia without pneumonia at baseline.Munro, C.L., Grap, M.J., Jones, D.J., McClish, D.K., & Sessler, C.N. (2009). Chlorhexidine, toothbrushing, and preventing ventilator-associated pneumonia in critically ill adults. American Journal of Critical Care, 18(5),428-37; doi: 10.4037/ajcc2009792This article is to test the effective ways or methods to prevent ventilator-associated pneumonia in critically ill adults. The population of the study included the critically ill adults in ICU who were intubated within 24 hours of admission. The strength of this study is that they have the patients divided randomly into 1 of the 4 treatments groups such as 0.12% solution chlorhexidine oral swab twice daily, or toothbrushing thrice daily, or both toothbrushing and chlorhexidine, or control group only has usual care. Another strength is that they have more methods to examine in the study. However, the weakness in the study is that the data were collected from the day of admission through day 7 of intubation or until extubation. There were 547 patients in the study, and by the third day there were only 249 patients in the study remained intubated were including in the analysis. The relevance of source to nursing is high because it showed in the study that using 0.12% chlorhexidine reduced early ventilator-associated pneumonia in patients without pneumonia at the baseline. Grap, M., Munro, C., Hamilton, V., Elswick, R., Sessler, C., & Ward, K. (2011). Early, single chlorhexidine application reduces ventilator-associated pneumonia in trauma patients. Heart & Lung: The Journal Of Critical Care, 40(5), e115-e122. doi:10.1016/j.hrtlng.2011.01.006This article is to examine if early, single chlorhexidine decreases ventilator-associated pneumonia in trauma patients. There were 145 patients who were intubated within 12 hours in the hospital as the population of this study. The study divided into two groups: control group and intervention group. Seventy-one patients in the intervention group used a single application of 0.12% chlorhexidine solution swab. There were 74 patients in the control group who only had usual care (no 0.12% chlorhexidine swab). The strength of the article is that they used a randomized controlled clinical trial which meant that patients were randomly assigned to groups. The weakness of the article is the population is too small. The relevance of source to nursing is high since it is important to promote oral care such as implementing 0.12% chlorhexidine swab to the patients to reduce and prevent patients from developing ventilator-associated pneumonia. The rationale for inclusion in this proposal is that it shows that using single 0.12% chlorhexidine solution may decrease the ventilator-associated pneumonia rate. ................
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