Staciwandell.weebly.com



Oral Care Reduces the Risk of Ventilator Associated PneumoniaStaci MasonFerris State UniversityAbstractResearch is developed from the formation of a clinical question that follows the format of PICO. The acronym PICO stands for patient or population, intervention or interest area, comparison intervention or current practice, outcomes desired, and time to achieve the outcome (the T in PICOT is optional and is not always used) (Nieswiadomy, 2012). The PICO question that was formulated for this paper was; what is the most effective intervention in decreasing ventilator-associated pneumonia (VAP) in adult ICU patients: performing oral care (use of tooth brushes or Toothettes) versus use of an antiseptic agent (Chlorhexidine)? A literature review was conducted of nursing research articles showing that the use of chlorhexidine significantly lowered the incidences of VAP. The use of chlorhexidine in combination with toothbrushes also showed a decrease in the incidences of VAP, whereas tooth brushing alone did not show any decrease in the risk of VAP.Oral Care Reduces the Risk of Ventilator Associated PneumoniaWhether you are a patient or a health caregiver you should desire evidence based practice (EBP) protocols to be in place. It is the most beneficial to the patient for the caregiver to be utilizing EBP; it provides the best and safest patient outcomes. “Nurses interpret research findings and use evidence-based research to support nursing decisions. The purpose of this assignment is to reflect how nursing knowledge is disseminated for use in personal and professional practice” (Ursuy, 2014).Clinical Question In the medical field caregivers are faced with life or death situations all of the time. It is up to them to make a correct and quick decision to save the lives of their patients. Caregivers are able to come to the best decision with evidence based nursing practice knowledge. It is up to each caregiver to stay informed with the new and upcoming research. Evidence based nursing research is based off of the best research evidence that has been done. Evidence based research is formulated from an acronym known as PICOT. This acronym assists researchers in writing clinical questions. The P stands for patient or population, I stands for intervention or interest area, C stands for comparison intervention or current practice, O stands for the outcomes desired, and T stands for time to achieve the outcome (the T in PICOT is optional and is not always used). (Nieswiadomy, 2012). This format of a clinical question allows researchers to break the question down into simpler parts for analyzing. It also allows for easy review of current practices to determine the best evidence based practices. The PICO question that I formulated was the following: What is the most effective intervention in decreasing ventilator-associated pneumonia (VAP) in adult ICU patients: performing oral care (use of tooth brushes or Toothettes) versus use of an antiseptic agent (Chlorhexidine)? I chose to evaluate this PICO question because VAP is a nosocomial (hospital acquired) infection that can be minimized by implementing meticulous oral care to prevent deaths amongst our adult intensive care unit patients. The patients that enter the hospital already have an infection or disorder occurring and do not need to add a nosocomial infection to their list. The facility that I work for has implemented a VAP protocol to aide in decreasing the risk of VAP from occurring.Once a researcher has formulated their PICOT question they begin to dive into other nursing research to determine what research has already been done on the subject. If it were a new research subject they would have to design a method to test their theory of the question. Once an answer to a specific PICO question is discovered it has to be analyzed by other nursing researchers to determine its validity and reliability. Once it surpasses those tests the information that was discovered from the PICO question is pitched to the education committee of the hospitals. The Educational Committee for each hospital then takes it, reviews it and implements the material into the units where they see fit. For example, the VAP protocol was implemented into the Intensive Care, Cardiac Care, and Neuro Care Units before it was implemented onto general medical surgical floors because they have more ventilators that they work with on a daily basis. The implementation of information that is discovered from a PICO question allows for better and safer care for patients while they are hospitalized. The implementation of oral care with an antiseptic agent such as Chlorhexidine reduces the risk of VAP, which reduces the patient’s mortality rate.Methodology The methodology that was utilized for this PICO question was a literature review using databases from Ferris State University FLITE library. The databases used were CINAHL, PubMED, and Sparrow Hospital Intranet. A literature review was conducted because the purpose of this paper was to research information that has already been discovered. (Nieswiadomy, 2012). The key terms that were used in the databases were Oral Care AND Ventilator associated pneumonia. Those key terms were used because it allowed for the best search on the topic. It narrowed the search down to “ventilator associated pneumonia” and “oral care.” The research that was conducted for this PICO question was limited to only nursing research. The reasoning for it to be limited to nursing research was because it only affects a nurse’s scope of practice. The individuals that implement the bedside care are the ones that are affected by nursing research therefore was not necessary to include advanced practicing nurses. The use of level of evidence is important when conducting research for a PICO question. Level of evidence is a level or (grade) that an article or certain research gets based off of its validity, reliability, and quality of design. The level of evidence pyramid that was utilized for this PICO question was Melnky & Fineout-Overholt, 2011. They determined that there is seven different levels with level one (systematic reviews and meta-analysis of randomized controlled trials) being the strongest level of evidence, and level seven (expert opinion) being the weakest (Melnky &Fineout-Overholt, 2011). This PICO question utilized two level one articles and two level three articles. Therefore the level of evidence for this specific PICO question’s research is moderately strong.Discussion of Literature Article OneThe first article that will be discussed is from American Journal of Critical Care, by Munro et al, titled, “Chlorhexidine, tooth brushing, and preventing ventilator associated pneumonia in critically ill adults.” This research was completed to determine the effects of mechanical (tooth brushing) versus pharmacological (chlorhexidine) interventions against VAP. The article was easy to read and understand with the purpose clearly stated. This research is a randomized clinical trial (RCT). According to Melnyk & Fineout-Overholt and RCT is considered to be a level one for level of evidence. In other words the article is considered to be reliable, valid and have a strong research correlation. The research that was performed was from three Intensive care units (ICU) for adult patients over a seven-day time period. The patients were scored on days three, five and seven after intubation to determine if they had VAP by using the Clinical Pulmonary Infection Score (CPIS). CPIS is obtained from six variables, they are the following; temperature, white blood cell count, tracheal secretions, oxygenation, findings on chest radiographs, and culture results of tracheal secretions. There were then four different oral treatments that the patient could receive; 0.12% solution of chlorhexidine by swab twice a day, tooth brushing three times a day, combination care (tooth brushing three times a day and cholorhexidine every 12 hours), or control care (normal oral care). The type of oral care that was delivered was randomly assigned to different patients (Munro et al, 2009). The results after seven days were “Chlorhexidine oral swabbing was effective in reducing early VAP in patients in medical, surgical/trauma, and neuroscience ICUs who did not have pneumonia at baseline. Tooth brushing did not reduce the incidence of VAP, and combining tooth brushing and chlorhexidine did not provide additional benefit over use of chlorhexidine alone” (Munro et al, 2009, p. 8). This study can be utilized in everyday practice by encouraging nurses to provide meticulous oral care by following oral care protocols to save their patients lives. Article TwoThe second article that will be discussed is from The Journal of Dimensions of Critical Care Nursing, by Parsons et al, titled “Oral Care and Ventilator- Associated Pneumonia. This research was an integrated review of literature of over twenty articles was easy to read and interpret. The purpose of this research was to review evidence-based research to determine if the best evidence based research was being utilized. According to Melnyk-Fineout-Overholt a systematic review of literature is considered to be a level one. A level one on the pyramid of level of evidence is known to be a strong research article and is reliable.The research for this article was a literature review of previous evidence based research. The literature review was articles that were published from 2006 to 2012 using the key words “oral care” and “ventilator-associated pneumonia” with the emphasis of the research focusing on the oral care aspect. The outcomes from the review was that ICU nurses rank oral care for mechanically vented patient has a high priority and that oral care should be key in the plan of care and should be documented appropriately (Parsons et al, 2013). The solution that was most used was chlorhexidine to decrease the risk for VAP. The conclusion to the review agreed that VAP bundles (including chlorhexidine) of care interventions have reduced the incidence of VAP significantly (Parsons et al, 2013). The knowledge gained from this literature review will prove that the VAP bundles with cholorhexidine will aide in preventing VAP. It will also provide educational evidence when implementing to hospitals.Article ThreeThe last article that will be discussed is from American Journal of Infection Control, Eom et al, titles “The impact of ventilator bundle on preventing ventilator-associated pneumonia: A multicenter study.” This research article was based off of a controlled trial with no randomization. The purpose of this article was to determine if the implementation of the VAP bundle (which included oral decontamination with chlorhexidine 0.12%) reduced rates of VAP. According to Melnyk & Fineout-Overholt a controlled trial is a level three on the pyramid of level of evidence. A level three is considered to be from a well-controlled trail with good research. It is still considered to have moderately strong research correlation it just has some limitations because there is no randomization.This study was performed in six Korean hospitals that all had comparable VAP rates. The objective of the study was to implement the VAP bundle, which consisted of head of bed elevated, peptic ulcer disease prophylaxis, deep venous thrombosis prophylaxis, and oral decontamination with chlorhexidine 0.12%; none of the six hospitals had a VAP bundle in place prior to the study. There was an infection control practitioner that rounded daily to ensure that compliance to the VAP bundle was occurring. Before initiation of the VAP bundles in the Korean hospitals they were fifty-seven cases of VAP reported from July 2010 to February 2011 (4.08 events/1000 ventilator days), after initiation there were only seven cases from March 2011to June 2011 (1.16 events/1000 ventilator days) (Eom et al, 2014). This study came to the conclusion that “Compliance with oral decontamination with chlorhexidine 0.12% had the greatest impact on VAP reduction” (Eom et al, 2014, pg. 36). This study is a perfect example of why bundles and protocols in the hospitals should be followed. The risk of a nosocomial infection was decreased dramatically once caregivers became complaint with the new policy.Significance to NursingThe evidence that is discovered from a PICO research question can benefit a caregivers every day practice. The knowledge that is gained from the research allows caregivers to provide the best care possible. For this specific instance the implementation of chlorhexidine as the oral care protocol provides patients that are intubated a decreased risk of falling victim to VAP. If a patient acquires VAP their chance of death also increases. It is crucial that PICO question research is integrated and updated into a caregivers practice to ensure that every patient everywhere is receiving the same evidence based care.The Quality & Safety Education for Nurses (QSEN) is a “comprehensive, competency based resource to empower nurses with knowledge, skills, and attitudes to improve quality and safety across healthcare system” (Project Overview, n.d.). The QSEN institute has multiple teaching strategies that can be implemented to increase our patient’s quality of care. In the tab labeled video there is a video called “The Josie King Story.” Josie was a sweet little girl who fell through the cracks. Her mother and father sought help by asking nurses and other caregivers to assess their daughter but everyone reassured her that Josie was fine. In the end Josie died due to medical errors. The reason that nursing research needs to be done is to prevent situations like this. If there is more research and more knowledge gained everyday it can save lives. It is important to have research conducted and to implement it into caregiver’s everyday care. Everyday new and better techniques and knowledge are learned. It is crucial to integrate this into everyday care so that patients are truly receiving the best quality care possible.The impact of implementing chlorhexidine into everyday practice for a patient that is mechanically ventilated has decreased the risk of mortality. Currently at Sparrow Hospital there is an “Oral care for Adult Ventilated Patients” policy that is to be followed by every caregiver working with a ventilated patient. According to the policy that evolved from a PICO researcher, the best evidence based protocol is as follows “obtain new oral kit from supply pyxis every 24 hours, change oral suction and closed suction tubing every 24 hours, store yankauer suction catheter in the upright position, and to provide oral care every two-four hours on ventilated patients” (Warren, 2012, p. 1). The decision to utilize the evidence was reviewed by an educational research committee and then reviewed by the units. Sparrow hospital determined this policy was best because it had the evidence to support it and provided the optimal care for the patients.It turns heads when evidence is discovered that a patient’s mortality rate can be decreased by simply providing meticulous oral care every two to four hours with an antiseptic solution. Every caregiver strives for the best possible patient outcome; implementing newfound knowledge into hospitals everyday care impacts the outcomes. The American Nurses Association (ANA) holds each and every nurse to their Scope of Practice standards they should live by. Standard five is implementation, which means, “nurses implements the interventions identified in the plan” and standard nine, which is evidence, based practice and research, meaning, “registered nurses integrate evidence and research findings into practice”(ANA, 2010). When new research is involved it is crucial that the new knowledge is implemented and integrated into the patients care to provide, the best patient outcome, which is standard three. Although all nurses everywhere all the time should live by all sixteen standards that are set before us by the ANA; the last one that is discussed is standard ten. Standard ten is quality of practice, “the registered nurse contributes to quality of nursing practice” (ANA, 2010). Each and every patient deserves the best quality care and it is the nurse’s duty to provide that to the best of their ability. Implementing research knowledge into their everyday practice is one of the best ways to provide quality practice. ReferencesAmerican Nurses Association (ANA) Scope and Standards of Nursing Practice, 2010Eom, J., Lee, M., Chun, H., Jung, S., Kim, Y., Yoon, S., Kwak, Y., Oh, G., Jeon, M., Park, S., Koo, H., Su, Y., & Lee, J. (2014). The impact of ventilator bundle on preventing ventilator associated pneumonia: A multicenter study. American Journal of Infection Control, 42(1), 34-37.Melnyk, B.M. & Fineout-Overholt, E. (2011). Evidence-based practice in nursing and healthcare: A guide to best practice. Philadelphia: Lippincott, Williams & WilkinsMunro, C., Grap, M., Jones, D., McClish, D., & Sessler, C. (2009). Chlorhexidine, tooth brushing, and preventing ventilator associated pneumonia in critically ill adults. American journal of critical care, 18, pg. 428-437. Doi: 10.4037/ajcc2009792Nieswiadomy, R. M. (2012). Foundations of nursing research. (6th edition). Upper Sadle River, NJ. Pearson.Parsons, S., Lee, C. A., Strickert, D., & Trumpp, M. (2013). Oral Care and Ventilator-Associated Pneumonia. Dimensions Of Critical Care Nursing, 32(3), 138-145. doi:10.1097/DCC.0b013e318286482aProject Overview | QSEN (QSEN). , P. (2014). Nurse 350 ferris state university spring-2014.PAU. retrieved from: , C., 2012. Oral Care for adult ventilated patients. Sparrow Policy. ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download