Development and Evaluation Implementing a Clinical Nursing Practice Guideline for Critically Ill Patients Receiving Mechanical Ventilator in a Medical Intensive Care Unit.

Abstract

Background : Ventilator-associated pneumonia (VAP) is a major complication among critically ill patients receiving mechanical ventilation and contributes to prolonged ventilator use, longer hospitalization, increased cost, and patient-safety risks. A context-specific, evidence-informed Clinical Nursing Practice Guideline (CNPG) is therefore an important strategy to strengthen nursing quality and reduce VAP-related risks in intensive care settings.

Objectives : 1) To update nursing practice guidelines for critically ill patients on mechanical ventilation. 2) To evaluate clinical outcomes, specifically VAP incidence, re-intubation rates within 72 hours, and length of stay.

Materials and Methods : This implementation research was conducted in two phases: guideline development and real-world implementation in the Medical Intensive Care Unit of Hat Yai Hospital. The CNPG was developed using the NHMRC framework and synthesized into the WHAPO guideline: Weaning, Hand hygiene, Aspiration precaution, Prevention of contamination, and Oral care. Twenty-four registered nurses were trained and implemented the guideline with 200 mechanically ventilated critically ill patients, divided into 100 pre-implementation and 100 post-implementation cases, from June to November 2022. The guideline was validated by experts (CVI = 0.85), and data were analyzed using descriptive statistics, baseline comparison, and appropriate comparative tests according to data type.

Results : Overall adherence to the WHAPO guideline increased from 77% to 86% after implementation. The mean duration of mechanical ventilation decreased from 9.18 to 8.80 days, and the VAP incidence rate decreased from 16.51 to 13.31 per 1,000 ventilator-days. Although the differences were not statistically significant (p > .05), the direction of change indicates a positive clinical trend in patient safety and nursing-care quality.

Conclusion : The WHAPO guideline, developed from evidence-based recommendations and supported by training, clinical supervision, and feedback loops, was feasible for clinical implementation and demonstrated positive trends in clinical outcomes. Future studies should apply a controlled before-after or quasi-experimental design with systematic severity assessment to enhance causal interpretation and support sustainable scale-up.