Effectiveness of Implementing the Ventilator Care Bundle in Adult Critical Care Units Nakornping Hospital

Authors

  • อิสรีย์ ตระกูลพานิชย์กิจ Nakornping Hospital, Chiang Mai
  • ชนกพร อุตตะมะ Nakornping Hospital, Chiang Mai
  • นาฏยา เอื้องไพโรจน์ Nakornping Hospital, Chiang Mai
  • ดรุณี ไชยวงค์ Nakornping Hospital, Chiang Mai
  • จรรยา กาวีเมือง Nakornping Hospital, Chiang Mai

Keywords:

Ventilator - associated pneumonia (VAP), Ventilator care bundles

Abstract

Ventilator care bundles (VCBs) is an evidence based practice (EBP) tool for quality improvement. The purpose of this operations study was to determine the effectiveness of implementing VCBs in 7 adult critical care units (ICUs), Nakornping Hospital during September 2017 to May 2018. Subjects included 501 patients with mechanical ventilation who were admitted in ICUs before implementing VCBs and 649 patients with mechanical ventilation after implementing VCBs. The tool consisted of 1) The VCBs developed by researchers. 2) An outcomes evaluation form included VAP rate, ventilator days, Length of stay (LOS) in ICU, and medical costs. The study was based on a framework of development and implementing clinical practice guidelines of the Australian National Health and Medical Research Council (NHMRC, 1999). Data analysis was done using descriptive statistics. The findings revealed that:

The incidence rates of VAP before implementing the VCBs were 20.27 per 1000 ventilator- days, while after implementing the VCBs were 7.03 per 1000 ventilator-days. The median of ventilator days among subjects before implementing the VCBs were 3 days, while the median among subjects after implementing the VCBs were 2 days. The median of LOS among both groups of subjects were equal 4 days. The mean of medical costs before implementing the VCBs were 93,041.19 bath and after implementing the VCBs were 80,085.26 bath

The findings of this study verify that implementing the VCBs as a tool for Improving quality of care among patients with mechanical ventilation in ICU at Nakornping Hospital can mainly achieve desirable outcomes. Therefore, this VCBs should be integrated in the routine care of the patients with mechanical ventilation.

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References

Lea, F., Farenzena, M., Wawrzeniak,LC., Brauner, J.S., Rios Vieira, S.R., Vigo, A., & Bozzetti, M.C. Mechanical ventilation in patients in the intensive care unit of a general university hospital in southern Brazil: an epidemiological study. Clinics (Sao Paulo). 2016, Mar;71(3), 145–151.

Helley,T.P., Ewan, V., Wilson, P., & Simpson, A,J. The intensive Care Society recommended bundle of interventions for the prevention of ventilator-associated pneumonia. Jics. 2016;17(3):238 – 243.

Magill, S.S., Edwards, J.R., Bamberg, W., Beldavs, Z.G., Damyati, G,. Kainer, M. A., et al. Multi state point- prevalence survey of health care-associated infections. The New Eangland journal of medicine. 2014;370(13):1198 – 208.

Thailand Hospital Indicator Project. โครงการพัฒนาระบบสารสนเทศเปรียบเทียบวัด ระดับ คุณภาพ โรงพยาบาล. [Online].2016. Available at : http://www. ha.or.th/ha2016/thip/thip. htm. 2 Sep 2016

Gallagher, J. A. Implementation of Ventilator- Associated Pneumonia Clinical Guideline (Bundle). American college of Nurse Practitioners. 2012;8(5). 377-82.

Keyt, H., Faverio,P., & Restrepo,MI., Prevention of ventilator-associated pneumonia in the intensive care unit: A review of the clinically relevant recent advancements. Indian J Med Res. 2014;139, June, 814-821.

Hadi D. K., Amir E. Z., Abolfazl F., Afshin G. B., Ghahraman M., Farshad H. K., et al. The Importance of Oral Hygiene in Prevention of Ventilator – Associated Pneumonia (VAP) A Literature Review. International Journal of Caring Sciences. 2014, 7:12 – 23. Retrieved Jan

Lim. K.P., Kuo, S.W., Ko, W.J., Sheng., W.H., Chang, Y.Y., Hong, M.C. Efficacy of ventilator associated pneumonia care bundle for prevention of ventilator associated pneumonia in the surgical intensive care units of a medical center. Journal of Microbiology, Im munology and Infection. 2013;122, 1 - 6.

ศูนย์ข้อมูลโรงพยาบาลนครพิงค์. รายงานข้อมูลประจำปี 2559.เชียงใหม่: โรงพยาบาลนครพิงค์; 2559.

งานป้องกันและควบคุมการติดเชื้อในโรงพยาบาล โรงพยาบาลนครพิงค์. รายงานการติดเชื้อใน โรงพยาบาล ปี 2560. เชียงใหม่: โรงพยาบาลนครพิงค์; 2560.

Alcan, A.O., & Korkmaz, F.D. Prevention of ventilator-associated pneumonia: Use of the care bundle approach. American Journal of Infection control. 2016; 44, e173 – e176.

National Health and Medical Research Council (NHMRC). A guideline to the development implementation and evaluation of clinical practice guideline. 1999. Retrieved April 12, 2016, from http://www.nhmrc.gov

วันดี ศรีเรืองรัตน์. การพัฒนาและประเมินผลการใช้แนวปฏิบัติการพยาบาลในการป้องกันปอดอักเสบ จากการใช้เครื่องช่วยหายใจในหอผู้ป่วยหนัก โรงพยาบาลหาดใหญ่ วิทยานิพนธ์ปริญญา พยาบาล ศาสตร์มหาบัณฑิต สาขาการพยาบาลผู้ใหญ่ คณะพยาบาลศาสตร์ มหาวิทยาลัยสงขลานครินทร์; 2556.

Speck, K., Rawat, N., Weiner, N. C., Tujuba, H. G., Farley, D., & Berenholtz, S. Asystemic approach for developing a ventilator-associated pneumonia prevention bundle. AJJC. 2016;44:652 - 6.

Marini, A. L., & Shihab, R. K. Multifaceted bundle interventions shown effective in reducing VAP rates in our multidisciplinary ICUs. BMJ Quality Improvement Reports.2016; 5,1245-1250.

Wang, J., Ma, Y. & Fang, Q. Extubation With or Without Spontaneous Breathing Trial. American Association of Critical-Care Nurses. 2013; 33(6) : 50- 56. doi: http://dx.doi. org/10.4037/ccn2013580

Burry ,L., Steinberg, M., Rose, L., Kim, S., Devlin, J., Ashley, B. J, et al. Clinicians’ perspectives on the use of a sedation protocol or daily sedative interruption in me chanically ventilated patients enrolled in a multicenter sedation trial. Intensive Care Medicine. 2011;37(1),83-90.

Krag, M. A., Perner1, J. Wetterslev, M. H., & Møller. Stress ulcer prophylaxis in the intensive care unit: is it indicated? A topical systematic review. Acta Anaesthesiol Scand. 2013;57:835–847. 

Alhazzani, W., Alenezi, F., Jaeschke, R.Z., et al. Proton pump inhibitors versus histamine 2 receptor antagonists for stress ulcer prophylaxis in critically ill patients: a systematic review and meta- analysis. Crit Care Med. 2013;41,693-705.

Sole, M. L., Su. X., Talbert, S., Penoyer, D. A., Kalita, S., Jimenez, E., & Bennett, M. Evaluation of an intervention to maintain endotracheal tube cuff pressure within therapeutic range. American Journal of Critical Care. 2011;20(2):109-118.

Metheny,N. & Frantz, R. Head-of-Bed Elevation in Critically Ill Patients: A Review. Critical Care Nurse. 2013;33(3):53-67.

Zuckerman,L. M. Oral Chlorhexidine Use to Prevent Ventilator-Associated Pneumonia in Adults. Dimens Crit Care Nurs. 2016;35(1):25-36.

Liang, J.F., Tian, R., & Feng, L. Clinical experience of spontaneous breathing trial in weaning mechanical ventilation Chinese. critical care medicine. 2009;Oct;21,(10), 617-20.

Shahab, M., Yousefi, H., Yazdannik,A,. & Alikiai, B. The effect of daily sedation interruption protocol on early incidence of ventilator-associated pneumonia among patients hospitalized in critical care units receiving mechanical ventilation. Iran J Nurs Midwifery Res. 2016; 21(5), 541–546. doi: 10.4103/1735-9066.193420

Sedwick, M.B., Lance-Smith, M., Reeder, S.J., & Nardi, J. Using evidence – based practice to prevent ventilator-associated pneumonia. Critical care nurse. 2012;32(4):41-51.

พนิดา กาวินำ ทองปาน เงือกงำ และ ศรีสุดา อัศวพลังกูล. ผลการพัฒนาโปรแกรมส่งเสริมการใช้แนว ปฏิบัติการพยาบาลในการป้องกันการติดเชื้อปอดอักเสบจากการใช้เครื่องช่วยหายใจ. วารสารกองการ พยาบาล. 2560;44(3),34 – 57.

Sulis, C, A., Walkey, A, J., Abadi, Y.,Reardon, C. C., Joyce-Brady,M. Outcomes of a ventilator-associated pneumonia bundle on rates of ventilator-associated pneumonia and other health care-associated infections in a long-term acute care hospital setting American Journal of Infection Control. 2014;42:536- 8.

Published

2018-06-01

How to Cite

ตระกูลพานิชย์กิจ อ., อุตตะมะ ช., เอื้องไพโรจน์ น., ไชยวงค์ ด., & กาวีเมือง จ. (2018). Effectiveness of Implementing the Ventilator Care Bundle in Adult Critical Care Units Nakornping Hospital. Journal of Nurses Association of Thailand Northern Office, 24(1), 39–60. Retrieved from https://he01.tci-thaijo.org/index.php/jnorthnurse/article/view/196188

Issue

Section

Research Articles