Quality Improvement Strategies on Reducing Ventilator Associated Pneumonia - Essay Example

QUALITY IMPROVEMENT STRATEGIES ON REDUCING VENTILATOR ASSOCIATED PNEUMONIA IN INTENSIVE CARE UNIT QUALITY IMPROVEMENT STRATEGIES ON REDUCING VENTILATOR ASSOCIATED PNEUMONIA IN INTENSIVE CARE UNIT Introduction Ventilator associated pneumonia (VAP) is one of the most common hospital-acquired infection, which occurs among patients utilising mechanical ventilation. The fundamental effects of contracting this infection include increased mortality of patients, prolonged hospitalisation and high medical bills caused by the infection and the prolonged hospitalisation. Reduction of the infection is essential in seeking to avert these adverse effects of the infection on both the patient’s health and social well-being. This infection occurs through the pathogenic bacterial colonisation of aerodigestive tract. The strategies utilise in the prevention of the infection aim at ensuring the aversion of bacterial colonisation, in seeking to effectively manage this nosocomial infection. A quality improvement strategy aimed at preventing these infections would be focused on the medical staff because of the associated causes of the infections. This is a close association between the inadequate staffing in the healthcare facilities and the occurrence of this infection. Educating the current staff would present an effective approach in seeking to enhance the prevention of the infections given the limited resources available within the ICU setting. Despite the various approaches that have been taken in seeking to avert the occurrence of these infections, there are indications of continued rise in the occurrence of these infections. This has resulted in professional and national agencies insisting on the healthcare facilities refocusing their preventive measures. Many organisations have adopted different strategies in seeking to prevent the occurrence of these nosocomial infections. New Education Programme The provision of healthcare services depends heavily on the skill level and the knowledge possessed by the caregivers. Within the ICU setting limited knowledge is one of the fundamental factors resulting in nosocomial infections like VAP. Educational interventions commonly aim at enhancing the knowledge of the employees in seeking to enhance their skill in service delivery. A new education programme focusing on increasing the knowledge of nurses regarding the infections is essential in ensuring effective prevention of the condition (Viana et al., 2013). The ever increasing number of VAP infections has resulted in the consideration of different education approaches seeking to enhance the medical skills of the nurses providing care within these facilities There is a substantial lack of knowledge among many ICU professionals regarding the prevention of VAP. A study conducted in Europe regarding the knowledge of ICU professionals on the prevention of VAP indicated that many nurses answered about 45% correctly on the prevention of VAP in hospital ICU (Labeau et al., 2008). This lack of knowledge raises fundamental concerns regarding the knowledge of individuals working within the ICU setting. The improvement of their knowledge is a critical factor in enhancing their understanding of different elements surrounding the occurrence of the infection. Focusing on the VAP during the education programme is essential in enhancing the understanding of the condition by the care givers. This would enable the caregivers to understand the significance and importance of the care provision in relation to prevention of the infection. Educational training has been identified as one of the effective measures in enhancing quality, especially within settings where there are limited resources. While there is a relative advancement on the antimicrobial therapy within the healthcare sector, improvement of the basic care among intubated patients is essential in eliminating the occurrence of VAP. Training programmes for ICU professional have demonstrated a significant reduction in VAP infection rates within different locations (Ross & Crumpler, 2007). The implementation of an educational programme is essential for the healthcare facility in seeking to enhance the quality of care provided. Involvement of all professionals working within the ICU would significantly enhance the attention of the professionals to details. This would mitigate the risk factors leading to the occurrence of the infection and result in better performance of the ICUs. The utilisation of an educational intervention aimed at preventing occurrence of VAP is essential in ensuring the sustainability of the programmes initiated for similar purposes. The education programme is the best and most effective approach that could be adopted for successful management of the preventive measures. The educational approach would include conducting an analysis of the fundamental requirements of the hospital employees in seeking to enhance their understanding of the infection and the different factors resulting in occurrence of the infection. Education would provide the employees with an increased level of knowledge, which would be essential in the establishment of a sustainable preventive approach for the infection(Bouadma et al., 2010). Through education the various stakeholders of the programme would be enlightened on the causative factors, which would be an effective approach in reducing infections. Implementation Issues for the New Education Programme The implementation process of the educational programme would be faced by numerous factors that would allow for its successful implementation. Evaluation of the positive and negative aspects of the implementation process is essential in seeking to ensure successful implementation of the programme. This would enable the organisation seeking to implement the education programme to make an informed analysis of the impact of implementing the programme. The fundamental issues surrounding the implementation process the factors discussed below. Success in other places – education programmes have been established as effective in the prevention of VAP infections within different regions. Conducting educational training has been established as effective in reducing the occurrence of these infections (Youngquist et al., 2007). This is an essential element that would be a motivation for the implementation of the programme within this healthcare facility. Based on the available information regarding effectiveness of the education programme, the healthcare facility would be in good position to analyse the effectiveness of the approach. Ease of implementation – since the educational approach has been extensively utilised within other facilities, there is an increased knowledge on the implementation process. Availability of information is essential in ensuring effectiveness of the implementation process within many healthcare facility settings. This makes the education programme be a relatively easy intervention to implement within the hospital (Murray & Goodyear-Bruch, 2007). Once the knowledge has been transferred to the ICU professionals, the sustainability of the programme is relatively easy since there will be increased collaboration between the various professionals. Benefits of the implementation – the conduction of educational training is presents various benefits to the organisation, which include the effectiveness of the ICU performance. During the education training programme various nursing practices, like teamwork, be enhanced. While these elements are essential in the prevention of VAP, these skill also be essential in the undertaking of other responsibilities involved in the professional practice (Reeves et al., 2008). The effectiveness of the hospital ICU is enhanced through the improvement in the service delivery, which is learnt during the new education programme implementation. While the fundamental Benefits of the education programme might be aimed at prevention of VAP, the effectiveness of the ICU performance would be essential in the management of other related infections that might occur within the ICU(Reader, Flin, Mearns, & Cuthbertson, 2009). Challenges – there are numerous challenges which will face the implementation of the programme in relation to the successful implementation. The resources within many ICU setting are limited and getting the essential resources to conduct the educational training is a challenge that might have detrimental effect on the implementation process. The limitations in resources might present a significant challenge in the establishment of the prevailing risks within the hospital setting (Esmail et al., 2008). In the implementation process, assessment of the fundamental risks is essential in understanding the approaches that would be applied for best outcomes of the implementation process. Another fundamental challenge in the implementation process is the staffing concerns within the various ICUs, which continue to make implementation be relatively difficult. Many of the ICU is inadequately staffed making it extremely difficult to the available staff to manage attending the education training while ensuring they undertake their responsibilities effectively (Hillier et al., 2013). Implementation strategies There are various strategies that can be utilised in the quality improvement aimed at reducing the occurrence of VAP infections within hospital ICUs. Educational training for many nurses is a multifaceted approach that is essential in the mitigation of numerous factors that result in the occurrence of various nosocomial infections. While the education training programme enhances learning and other fundamental skills, the different strategies seeks to mitigate the causative factors. Various practices involved in the prevention and reduction of infections are reinforced through the implementation of education programme aimed at enhancing the understanding of the ICU professionals. This educational training involves informing the individuals about the existing policies and the compliance to the regulations regarding provision of services within the healthcare sector. The education programme will be focused on different facets, which will include the elements discussed below. Staff education – conducting education among the staff is essential in enhancing the knowledge of the care givers in the provision of services. Education is fundamental in enhancing the skills of the professionals regarding the understanding of different elements. Education will provide the professional with increased knowledge on the causes of the infections and enable the professionals to improve their service delivery skills (Rello et al., 2010). The betterment of the ICU performance comes through the understanding of the effective operations, which include communication and team work within the working environment. Teamwork and communication is some of the fundamental elements learnt through educational training, and that are essential in the improvement of services provided within ICU wards (Hawe et al., 2009). Hand hygiene – this is another fundamental element of focus for the education programme being implemented within the hospital. The caregivers commonly come into direct contact with the patients, and maintaining high level of hygiene is essential in the betterment of services. Poor hygiene is a fundamental factor that results in the occurrence of various nosocomial infections (Allegranzi & Pittet, 2009). Education training will be focused on emphasising the relevance of hygiene in the prevention of infections. The ICU professional must understand the fundamental practices that increase the risk of infection within the ICU setting. This will be an essential element aimed at ensuring reduction of the infection within the ICU. Keeping patient in semi-recumbent position – semi-recumbent position can be described as the inclination of a patient in seeking to enhance the natural ventilation through the tracheal tubes. The occurrence of the infections commonly occurs through the bacterial attachment to the equipment utilised in providing mechanical ventilation to patients. The fundamental application of the semi-recumbent positioning is ensuring the patient does not utilise the mechanical ventilation, which presents the infection risk upon many patients (Rose et al., 2010). The education training would be essential in teaching the professional staff about the relevance of this approach in reducing VAP infections within ICUs. The professional would be informed of approaches that they can utilise in achieving effective semi-recumbent position among hospitalised patients. Different elevations are utilised when performing different functions and these will be understood through education programme. Avoiding gastric over distension– gastric over distension commonly occurs through pumping increased level of air into an individual when applying resuscitation. During mechanical ventilations this is one of the fundamental hazards, which can result in the occurrence of an infection related to VAP. The education programme presents an essential understanding of the various approaches that professionals can utilise in avoiding gastric over distension in seeking to mitigate some of the hazards of mechanical ventilation (Bouadma, et al., 2010). The education programme will be essential in providing information regarding avoiding occurrence of gastric over distension and the methods of treating the effects of the distension when it occurs. One of the fundamental effects of gastric over distention is the occurrence of aspiration pneumonia, which would be avoided through eliminating the occurrence of this condition. Ventilator weaning – the application of mechanical ventilation is essential in the treatment of patients suffering from breathing conditions. Despite the necessity of mechanical ventilation, the ICU professionals must at one time cease the utilisation of mechanical ventilation. This cessation becomes an essential element that must be understood by the ICU professionals in seeking to ensure effective prevention of infection through ventilator weaning (McConville & Kress, 2012). The professional will be acquainted with the requirements of ventilator weaning in seeking to ensure they understand different strategies aimed at reducing the time that a patient requires mechanical ventilation. The Implementation Stakeholders The programme will include various stakeholders who will be involved in the implementation process of the programme. The stakeholders will be the individuals who shall be directly affected the programme. The focus of the programme will be the different professionals working within the ICU setting of the hospital (Kollef, 2012). There shall be numerous individuals who will be directly involved in the implementation of the programme. The stakeholders will include the following individuals. Nurses These will be the major stakeholders of the programme and the target for educational training of the programme. These professionals have a fundamental role the programme as they are involved in the direct provision of services within the ICU environment. The quality improvement initiative will be implemented through enhancement of the skills and knowledge of the nurses (Augustyn, 2007). Since they are the individuals providing services, they will be the direct recipients of the learning elements within the education programme. The collaboration of the nurses will be essential in the successful implementation of the programme. These stakeholders will be directly involved in the delivery of quality services and the outcomes will be evaluated through the nurses. Patients The fundamental purpose for implementing the quality improvement strategy is achievement of client satisfaction through reduction of nosocomial infections. These infections become determinants of the quality of service received from the hospital based on the patient experience. Occurrence of infections commonly damages the reputation of the hospital, from the patients’ perspective. Other stakeholders The other stakeholders will be involved in provision of limited services to the programme and at different stages. The educators and instructors will be involved in conducting education training among the ICU professionals, while other stakeholders like the institution administrators will be expected to provide support in terms of resources that will be utilised in undertaking the education programme. Implementation Timeline The implementation timeline will involve the effective management of different activities aimed at ensuring successful implementation of the programme. The activities will include Planning for the programme – this will involve the collection of the essential resources that will be required in the implementation of the process. Teaching of the basic education elements – a class like setting in which the instructors will provide essential information regarding various elements required. Initiating the various aspects that have been taught – these will involve the application of the different approaches which have been defined as effective in reduction of infections. Evaluation – this will be conducted in seeking to establish the success that has been achieved through the various elements that have been implemented. The implementation process will follow Lewin’s change management model which involves stopping some of the processes before implementing new approaches. In seeking to implement the changes, which will come through education of the various stakeholders, the organisation will have to stop the processes and then restart again after completion of the required elements of the project. This will be fundamental in providing the organization with enough time to analyse the various attributes which must be changed for effectiveness of the changes. Conclusion VAP is a nosocomial infection that could have detrimental effects upon the wellbeing of an individuals and the health status as well. The effects of these infections include prolonged hospitalisation and increased medical bills, which make preventive measure an essential necessity in the management of the conditions. Though mechanical ventilation is an effective approach for treatment of breathing problems, the intervention presents a fundamental hazard of contacting VAP (Ruffell& Adamcova, 2008). Different approaches and interventions have been utilised in seeking to reduce the rate of these infections, however, educational programmes are some of the effective and sustainable interventions. These programmes present various benefits to both the organisation and the various stakeholders involved within the implementation process. The fundament focus in the prevention of nosocomial infections is addressing the issues arising for various factors affecting the occurrence of these infections. References Allegranzi, B., & Pittet, D. (2009). Role of hand hygiene in healthcare-associated infection prevention. Journal of Hospital Infection, 73(4), 305–315. Augustyn, B. (2007). Ventilator-associated pneumonia risk factors and prevention. Critical Care Nurse, 27(4), 32–39. Bouadma, L., Deslandes, E., Lolom, I., Corre, B. Le, Mourvillier, B., Regnier, B., … Lucet, J.-C. (2010). 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