Overall plan for implementing the proposed solution
Overall methods used in the implementation of VAP prevention protocol was indicated as follows; head of the bed should be raised at an angle between 30° and 45°, then there is application of whole-body chlorhexidine-based medication which uses some small percentage of oil applied to recommended areas, then there is the process of thorough hand washing, then inclusion of adequate nutrition and administering early tracheotomy by the seventh day in the case of patients having endotracheal tubes. There is then the overall monitoring of staff compliance and the campaigns on the control of infections through the use of events, institutions of learning, and awareness on the benefits of good control practices and encouraging the practice of hand washing and universal precautions (Chinsky, 2002).
First of all, the team of physicians was reinforced with workforce capable of supervising the whole process as established. Then followed the discussions on the available cases of VAP with the physicians, this enabled obtaining of more information concerning the cases. Then finally, there was involvement of the Nurse clinicians in each and every process to ensure compliance to the expected results. In the process of implementation the hospitals were to implement protocols that reflected practices recommended by health care. Then the prevention protocols were to be used in evaluating the effects of nursing practices on the levels of VAP which would help in the releasing of the results (Chinsky, 2002).
There was need for educating the hospital staff which enabled them helps in enhancing the process of creating awareness of VAP prevention and at the same time able to work closely with the evidence-based rules provided by CDC. The implementation process also saw the need of sensitizing hospital staff on the need to improve on their working and performance capabilities. All the training should be undertaken within state approved health institutes (Chinsky, 2002).
There was need for using oral hygiene program which provides the required cleanliness. This ensured that the inclusion of the oral care protocol led to general improvement and assurance of the provision of the services. The ICU’s were to develop and incorporate oral hygiene protocol based on the trusted evidences available within the health care sector. There was need for available units to conduct the general evaluation of the outcomes obtained from the use of protocols (Chinsky, 2002).
Identifying resources needed for implementation of the proposed solution
There are several resources that could be used for the success of the process under discussion. One of the processes involves decontamination of the hands before and after handling the patient. This involved the use of gloves which in-turn help in the prevention of VAP. The other recommended items are the use of antimicrobial soap incase the hands are in contact with body fluids. The guideline recommended the washing of hands between contacts with various patients.
The whole process of education required full participation of the staff since the prevention of VAP requires combined efforts of medical practitioners. The use of endotracheal tube offers easy channel for entry of organisms to the lungs. There’s need for beds used to rest patients elevated at and angle of 30° to 45° from horizontal. This decreases the volume of gastric secretions which in turn reduces the risks of contacting VAP (Ibrahim et al, 2001).
Methods for monitoring solution implementation
The monitoring was done based on the impact of VAP on both mortality and morbidity rate. Medical practitioners are considered to play key roles towards prevention of VAP; this is since it forms part of their daily duty. In the process of educating medical practitioners, focus should be made on risk factors and the means through which the issue could be prevented. Monitoring tools are necessary besides development of protocols. In addition to these several methods were adopted to help in monitoring the whole situation. In the evaluation of the effects of VAP rates, there was need to use alternatives to antimicrobial soap which was identified as an improvement to hand-washing rates.
The development of unit-based studies also helps in identifying and monitoring the situation. Also to be applied was the use of supervision studies on health care workers that could help in determining the real practices involved in hand washing. The other monitoring method was the use of recorded information on the rate at which hand washing takes place. Such like methods were also proposed on the use of gloves in the process of giving oral care and during sub-glottic suctioning (Ibrahim et al, 2001).
Ways in which a theory of planned change was used to develop the implementation plan
The first stage of the theory involved becoming motivated to change (unfreezing). This phase of change was built on the theory that human behavior is established by past observational learning and cultural influences. The issue on change requires new principles on behavior. Unfreezing process has three sub-processes that relate to a readiness and motivation to change. In this scenario there was the problem involving VAP infections that affected patients who were generally subjected to ICU (Chinsky, 2002).
This gave the medical practitioners very difficult time, since majority of the patients suffered double attacks hence hindered them from achieving the defined medical objectives. This led to the implementation of Ventilator Aquired Pneumonia Protocol in the ICU. This required some training on the part of health care givers in order to prompt change and remove the survival anxiety. The process of learning on the ways to deal with the issue at hand was instituted but received some sort of resistance like ignorance on the use of antiseptic soaps due to the pain of having to learn new dimensions of performances. However, the change and implementation of the plan required a move past possible anxieties for results to be realized (Chinsky, 2002).
The second stage involved change in some aspects on the way patients were handled within the ICU, this was referred to as unfrozen and moving to new status. The level of VAP rate was so much prevalent leading to sufficient dissatisfaction with the current conditions under which patients were handled. This led to thorough research that desired some existence of change. There was necessity for identification of what needed some adjustment.
The consequences that followed the first process saw so many patients contracting VAP however the Implementation of Ventilator Aquired Pneumonia Protocol in the ICU reduced the rates of occurrences by some percentage. Precise methods were implemented, right equipments used and also educated people within the field of study involved. Plans were finally instituted to ensure that the adopted method of controlling VAP remains permanent (Craven, 2006).
Discuss the feasibility of the implementation plan
The use of bed set at 30° angle assisted in the need for improving the patient ventilation and the assessments done on daily basis concerning the readiness to extubate formed crucial part of the implementation plan. The act of sedation vacation helps in the reduction of time taken in mechanical ventilation. This enable the patients to cough and at the same time control secretions making the whole process easier. The disease known as Peptic Ulcer prophylaxis as revealed by meta-analysis studies showed that it controlled and at the same time reduces VAP rate and could even reduce the death rate. Reducing the acidity had positive results on breathing and digestive systems. Deep Venous Thrombosis (DVT) Prophylaxis also reduces the rates of occurrence of VAP when used as a pack of ventilator intervention (Craven, 2006).
Methods to be used in evaluating the innovation
The evaluation of the whole process was initiated using the Ventilator Bundle which reveals the evidences necessary for the whole practice. The strategy included the strategies used for the sustenance processes. This included setting the standard using the process on application of the ventilator bundle practice. Then there was the inclusion of the random auditing practices within the sections, which was used to prove on whether specific methods were applied appropriately. The other process involved continuous monitoring of the VAP occurrences and reporting any progress with the entire physician staff (Ibrahim et al, 2001).
The primary outcome measure was the existence of VAP relationship. The various cases of VAP were identified on the daily basis within the ICUs using on the methods laid down by the CDC. The various suspected cases were thoroughly scrutinized inclusive of the personal radiographs by the infection control team of nurses and physicians before the confirmation of VAP diagnosis. The same people within the infection control team were used during the study period.
The occurrence rates of VAP were defined within specific number of days. This was always done by the team, the days were known as ventilator days which signified the number of days patients were taken under mechanical ventilation. The secondary outcome was considered as the cost savings which resulted from the program measuring VAP bundle (Edwards et al, 2007).
Outcome data were collected concerning the incidence of new cases of VAP, death rate, the duration of time a patient takes under mechanical ventilation and the duration taken in hospital. It was not always easy to retrieve from the reports the timing of the diagnosis of pneumonia relative to the timing of the operation on mechanical ventilation (Warren et al, 2003).
Outcome measurement evaluation
The degree of VAP becomes more pronounced outcome as compared to other rates like the death rate. In such a case as this, the ignored estimate of treatment effect in studies without adequate blinding would support such like issue. Lack of allocation concealment is at times known to be associated with lack of credibility in the results of randomized controlled trials (Edwards et al, 2007).
The implementation of Ventilator Aquired Pneumonia Protocol in the ICU, it is still of a clinically significant importance. There are several possible reasons as to why reduction in the incidence of pneumonia would not be accurately linked with improvements in other outcomes. This would be in such cases as when the therapy has some link with other complications that negatively affect these outcomes. However, there should be adequate analysis on the anomalies that may occur (Edwards et al, 2007).
Ways in which the outcome measure is valid, reliable, sensitive to change, and appropriate for use in this proposed project. Assessment on the credibility of the outcome called for sensitivity during the grouping on the entire process. As the research analysts had indicated that the degree of rotation may be very crucial for the prevention of pneumonia. This made the study to perform subgroup analysis for those beds that rotated at different angles above thirty degrees.
Chinsky, D. (2002). Ventilator-associated Pneumonia: is there any Gold in these Standards? Chest, 122 (6), 1883-1885.
Craven, D., E. (2006). Preventing Ventilator-associated Pneumonia in Adults: Sowing Seeds of Change. Chest, 130 (1), 251-260.
Edwards, J. R., Peterson K. D, & Andrus M. L, (2007). National Health- care Safety Network (NHSN) Report. Am J Infect Control, 35 (5), 290-301.
Ibrahim, E., Tracy, L., Hill, C., Fraser, V., & Kollef, M. (2001). The Occurrence of Ventilator- washing Campaign, blood glucose control protocols, associated Pneumonia in a Community Hospital: risk Factors and Clinical Outcomes. Chest, 120 (2), 555-561.
Warren, K., Shukla, S., & Olsen, M. (2003). Outcome and Attributable cost of Ventilator Associated Pneumonia among Intensive Care Unit Patients in a Sub-urban Medical Center. Crit Care Med, 31(5), 1312-1317.