| Learning Objective #1: Describe the process utilized in the development of an evidence-based guideline for oral care in patients who are intubated and mechanically ventilated | |||
| Learning Objective #2: Analyze the effect of a standardized, evidence-based oral care protocol on improving patient health by decreasing the risk of infection in a population of intubated, mechanically ventilated patients in an intensive care unit |
The purpose of this paper is to describe the development of an evidence-based practice guideline for use in a clinical setting. The clinical problem addressed is: Does a evidence-based oral care protocol enhance patient health by diminishing the risk of infection in intubated, mechanically ventilated patients? The target population includes intubated, mechanically ventilated patients receiving care in an intensive care unit of a tertiary care medical center affiliated with a major university in the southeastern United States. There has been a nationwide trend of increasing rates of ventilator-associated pneumonia, and often with resistant organisms. There has been little published about the relationship between the provision of oral care and nosocomial pneumonia (Grap & Munro, 1997). In order to address this issue, a systematic approach was taken, which involved surveying the institutional policies already in place, conducting a literature search and review, grading the evidence in accordance with a published grading schema (Titler & Mentes, 2001). This resulted in the development of an oral care guideline aimed to decrease the incidence of infections in the target population. An action plan was created based on the application of Kurt Lewin’s change theory (1951). Additional components of the evidence-based guideline include the use of an oral assessment tool, the development of an educational component for the nursing staff with a post-test for assessment of knowledge, and evaluation of process factors and patient outcomes. Process factors are evaluated through the use of a process evaluation monitor tool. Outcome indicators to be evaluated include results of the oral assessment tool, nursing satisfaction with the guideline, and assessment of the number of patient ventilator days, patient morbidity and length of hospital stay. Use of this evidence-based oral care guideline is hoped to decrease the risk of infection in intubated, mechanically ventilated patients in the specified setting.
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