Paper
Wednesday, July 13, 2005
Measuring the Impact of Implementing Evidence-Based Practices to Reduce Ventilator-Associated Pneumonia Rates Using Benchmarking Data
Joan Stirlen, RN, MPH, Office of Performance and Quality, VAMC, Oklahoma City, OK, USA, Gayla Freeman, RN, MS, Surgeical/Operating Room, VAMC, Oklahoma City, OK, USA, Elsia Kodumthara, BSN, MSN, LSU, VAMC, Oklahoma City, OK, USA, Diana Sullivan, BSN, Urology, VAMC, Oklahoma City, OK, USA, Donna DeLise, RN, MS, OPQ, VAMC, Oklahoma City, OK, USA, and A. Renee Leasure, PhD, RN, CCRN, College of Nursing, Academic Programs, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
| Learning Objective #1: Identify two facilitators to the adoption of evidence-based practice changes
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| Learning Objective #2: Identify methods of reinforcing change using outcomes and benchmarking data
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In 1992 a nosocomial ventilator-associated pneumonia incident of 35 per 1,000 “at risk” ventilator days was identified as compared to the National Nosocomial Infection Surveillance rate of 15. A multidisciplinary team led by nurses was appointed to improve the structure and process of care delivery to reduce this alarming rate. Present practices were identified, the empirical literature was reviewed and reduction strategies identified. Changes were implemented sequentially in order to monitor the impact of the changes. Early changes did not require a substantial increase in work of the already burdened staff. Rather early changes implemented involved scheduled changing of ambu bags and the collection of a sputum culture within 24 hours of intubation and on admission from the operating room to the ICU. Two other practices were considered but rejected due to insufficient support: saline instillation and chest physiotherapy. Following an increase in infection rates in the cardiovascular surgery sub-group chlorhexidine oral rinse was included as a routine practice. Three senior staff nurses served as unit based “change champions” ensuring that literature supporting the practice change was available for ready review. These unit based resources were present to answer questions and served as a resource for residents as they rotated through the intensive care unit. Monthly outcome data was provided to the ICU staff verbally and through displayed graphical data in the staff meeting/break room. Feedback was also provided to the multidisciplinary critical care committee who was charged with overseeing unit performance. Changes were tracked over time with suggestions being submitted by interested parties to members of the multidisciplinary team. The trended feedback data which represented outcomes data for the unit and compared to an external benchmark reinforced the impact of the changes provided ongoing monitoring.