A Multi-Phase National Project to Implement Evidence-Based Nursing Related to Oral Care Nursing Practices of Intubated Patients

Paper

Wednesday, 19 July 2006

This presentation is part of : Strategies in the Acute Care Setting

Freda DeKeyser, RN, PhD, School of Nursing, Hadassah Medical Organization /Hebrew University, Jerusalem, Israel

Learning Objective #1: Describe the process taken by this group to implement evidence based nursing into critical care practice in Israel.
Learning Objective #2: Compare the results of a national survey of critical care nurses' reported oral care practices to the best available nursing evidence.

     The Evidence Based Practice Working Group of the Israeli Society for Cardiology and Critical Care Nursing began a national project to implement evidence based practice into critical care nursing in Israel. The group determined that oral care of intubated patients was an appropriate starting point as oral hygiene has been shown to be related to significant ICU complications and is under the domain of nursing .     It was unknown whether nurses were practicing evidence-based oral care. Therefore, the first phase of the project was a national survey of current practice. Questionnaires were distributed to ICU nurses throughout Israel. A sample of 216 questionnaires was obtained. Using a checklist of current products and practices, it was found that the vast majority of sampled nurses used gauze pads (84%) and tongue depressors (55%) with chlorhexidine (75%). Only about 1/3 used toothbrushes and toothpaste. While almost all nurses (95%) assessed their patients' mouths, no specific tool was used and there was no consensus as to when this assessment was made. Head nurses also reported that no unit (n =12) contained a written oral care protocol.
    The second phase was to collect patient data related to oral assessment, oral care received, and complications related to poor oral hygiene. This data were collected before the evidence based protocol was introduced.     The third phase of the project was the introduction of the new protocol into the ICUs. An evidence-based protocol was designed and was introduced into all of the units using a standardized presentation and curriculum.
    The fourth and last phase of the project, presently in progress, is the collection of data similar to the second phase, to determine whether there was an improvement in patient outcomes based on the new protocol.

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See more of The 17th International Nursing Research Congress Focusing on Evidence-Based Practice (19-22 July 2006)