Essay: Reducing the Risk of Pneumonia in Patients

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[. . .] This suggested not only the utility but also the feasibility of VCP. There are also indications in a study by Mukhtar (et al. 2014) that implementation of the VCP can have benefits even beyond that of reducing VAP: in a seven-month trial period of the VCP at one facility, it was found that "rates of methicillin-resistant Staphylococcus aureus acquisition, rates of vancomycin administration, intensive care unit lengths of stay, and durations of mechanical ventilation" were all reduced thanks to adherence to protocols. Another study by Rello (et al. 2013) of a "collaborative multi-centre cohort study" similarly found reductions in hospital stay duration and duration on the ventilator itself as well as VAP reduction using the VCP bundle.

Develop Recommendations for Change Based on Evidence

Thus, there is widespread support for the implementation of the VCP. Furthermore, any additional costs likely incurred as the result of its implementation will be outweighed by cost savings as a result of shortened hospital stays by the affected patients. The main additional expense as well as training is the oral care component of the VCP: "Subglottic tubes cost around $7 versus $1 for a standard breathing tube" (Guterl 2013).

Action Plan

Although some nurses are already familiar with the VCP, training of all personnel on the involved unit would be needed to ensure that there was a standardized compliance procedure and routine for all personnel, as well as supervisory roles for nurse leaders. After an initial training period for staff over the weekend, implementation could be swiftly phased in, provided all necessary implements are available (including subglottic tubes and chlorhexidine for oral care). Periodic retraining may be necessary over the next six months as well as monitoring to ensure compliance and to ensure that projected benefits were being demonstrated.

Evaluating Outcomes and Reporting Outcomes

Outcomes will be evaluated by comparing the rates of VAP before, during the training phase, and after the phasing in of the use of VCP bundles.

Identify Next Steps

If outcomes support that using the VCP protocol reduces VAP, additional data can be tracked such as reduction in the duration of hospital stays overall and duration of time patients must use mechanical ventilators in general. This will further support the use of VAP on an institutional basis within the hospital and in other institutions.

Disseminate Findings

Generating interest in and a commitment to the VCP means not only sharing data through meetings and annual reports between providers and administrators immediately involved in the policy but also in the hospital's newsletter and social media, the latter of which is widely consumed by staff and patients. Additionally, publishing the data in peer-reviewed journals can further the efficacy of the intervention outside the institution.

Conclusion

There is widespread support for an intervention to reduce VAP through adherence to a simple and relatively inexpensive protocol that is also supported by evidence-based research. Once initial buy-in by staff is achieved and after training is completed, internal data will hopefully likewise support the use of the VCP.

References

Al-Thaqafy, M. S., El-Saed, A., Arabi, Y. M., & Balkhy, H. H. (2014). Association of compliance of ventilator bundle with incidence of ventilator-associated pneumonia and ventilator utilization among critical patients over 4 years. Annals of Thoracic Medicine, 9(4), 221-226. doi:10.4103/1817-1737.140132

Guterl, G. (2013) Cost Implications of VAP. Retrieved from:

http://respiratory-care-sleep-medicine.advanceweb.com/Features/Articles/Cost-Implications-of-VAP.aspx

Lawrence, P., & Fulbrook, P. (2011). The ventilator care bundle and its impact on ventilator

associated pneumonia: a review of the evidence. Nursing in Critical Care, 16(5), 222-234. doi:10.1111/j.1478-5153.2010.00430.x

Mukhtar, A., Zaghlol, A., Mansour, R., Hasanin, A., El-Adawy, A., Mohamed, H., & Ali, M.

(2014). Reduced incidence of methicillin-resistant Staphylococcus aureus ventilator-associated pneumonia in trauma patients: A new insight into the efficacy of the ventilator care bundle. Trauma, 16(3), 202-206. doi:10.1177/1460408614532622

Rello, J., Afonso, E., Lisboa, T., Ricart, M., Balsera, B., Rovira, A., &... Diaz, E. (2013).… [END OF PREVIEW]

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