Evidence-Based Proposal (Research Proposal Sample)

Evidence-Based Proposal
Student’s Name
Institution
Ventilator Associated Pneumonia
Pneumonia is associated with approximately 10% to 15% of most hospitals-associated infections and causes 24% to 27% of all infections acquired in the coronary care unit (CCU) and medical intensive care unit (MICU) respectively. The purpose of this evidence-based proposal is to provide a possible solution to the reduction and elimination of ventilator based pneumonia (VAP). The proposal analyses the identification of the problem while proposing the solution and the way to implement and evaluate the desired solution. Mechanical ventilation and its requisite enndotracheal intubation are the primary risk factors in the development and incidences of ventilator-associated pneumonia. VAP rates range from 0-16 per ventilator days depending on the type of ICU, with the highest rates reported in trauma ICUs.
The proposed solution is the selective decontamination of the digestive tract (SDD) which has been subject to many trials under controlled and randomized systems. The implementation and constant evaluation of this technique into daily practice could significantly reduce mortality in the ICU. This proposal describes and discusses the concept of the digestive tract selective decontamination as a solution while summarizing the reviews of other peer reviewed evidence based journals in the medical field. The proposal will rationalize the risks of ventilator-associated pneumonia and the cost effectiveness associated with this life saving proposed solution. The paper will also suggest initiatives for improving patient’s care and their successful management aimed at ensuring favorable outcomes while reducing the mortality and morbidity. Finally, the paper will analyze the evaluation and dissemination plan, which entails evaluation regarding the effectiveness of the continuous training of the staff involved in VAP, SDD being the solution program.
Problem Description
Ventilator- associated pneumonia (VAP) occurs and affects on patients under mechanical ventilation in the hospital. It is a subtype of hospital –acquired pneumonia (HAP) and usually not characterized by the agents that causes it but rather limited to people undergoing mechanical ventilation (Hunter, 2012). Its consequence associated with tracheal intubation experienced by critically ill patients. Its likely pathogenesis is the successive colonization of the oropharynx followed by continuous aspiration of contaminated secretions.
Ventilator associated pneumonia has remained a significant issue in the medical setting with very high mortality, morbidity, and cost to the hospitals and patients at large (Alexis, Warren, David & Victoria 2002). Analyzing this condition is important in the provision and implementation of preventive measures in respect to the care given to mechanically ventilated patients. It is one of the leading causes of mortality in hospitals because of its nosocomial infections hence has a greater effect on morbidity of people hospitalized in the intensive care unit. There exist a significant correlation between complications in patients under mechanical ventilation and ventilator-associated pneumonia.
Ventilator- associated pneumonia (VAP) has been associated with increased health care cost in that it is the second most after urinary infections hence keeping patients long in the hospital. Considering the costs to the hospital, VAP is attributed to excess of stay, mortality, and ICU utilization in respect to bed cost, physical costs and, antibiotic cost (Sedwick, Mary, & Nardi 2012). Generally, this condition comes with cost, which translates to patient outcome because the increased microbial resistance fuelled by treatment of noscomial infections, complications, and secondary infections during increased ICU LOS, can be attributed to VAP. It is very clear that the impact of ventilator-associated pneumonia on patients’ conditions and Medicare system is significant and it has effects on patients’ outcome but the present considerate burden on hospital resources and intensive care unit. This condition is preventable but requires adequate preventive strategies coupled with excellent clinical practices.
Incorporating Theory
The solution I proposed for my research problem is the Selective decontamination of the digestive tract (SDD), which is one strategy being applied to prevent Ventilator-associated Pneumonia. SDD is centered on the application of antimicrobials with intent of eradicating pathogenic microorganism that may be present in the digestive tract. The aim of selective decontamination of the digestive tract is to eradicate pathogens from the stomach, oropharynx, and gut without altering protective micro- organisms (Lenneke, & Marcus, 2010). The theory that should be incorporated to make the proposed solution successful is the behavior change theory. Behavior change theory entails the use of evidence based clinical guidelines (CPGs) and encompasses implementation guideline strategy that will address the understood clinical barriers on guidelines on the proposed solution. The theory capitalizes on nurses and caretakers on intensive care units hence will reduce and improve on the outcomes of the ventilator-associated patients significantly.
The theory will be incorporated in my project through the guideline implementation strategies. Combination of various tools and mechanisms will enable the theory to alleviate the VAP incidences. These mechanisms will include computerized decision support systems, reminders, outreach visits, audit, and feedback. The behavior theory is best suited to dynamic and intensive care unit environment while incorporating organizational climate, multidisciplinary team, and the culture of ICU. The theory will provide framework through which change process can be initiated. To enable the proposed solution a successful one, critical components, which include effective feedback system, effective leadership, continued education program, and collaborative team, must be taken into consideration. Incorporating the theory and the proposed solution will eventually lead to reduction of pneumonia, mortality, and onset of resistance and bloodstream infections. The rationale behind this method is that numerous randomized trials based on clinical studies have suggested it is one strategy of dealing with patients with VAP and undergoing SDD as a medication strategy (Melsen, Smet, Kluytmans, & Bonten, 2012). The outcome of the theory assists in reduction of respiratory infections hence could reduce significantly the incidence of ventilator-associated pneumonia.
Implementation Plan
It is important to involve the organization’s main committees in the implementation plan of any process in a health policy. Considering the various committees as cardiovascular, respiratory, prevention, and women’s health departments is an initial step to take. The team involved in an evidence – based practice care program will take a step in giving approval to established guidelines, protocols, and order sets not usual in a particular department or category. Member comments should be considered, and protocols should consistent, as other existing protocol of the organizational final draft of approval, copy is developed and sent to the Institute for Clinical Systems Improvement (ICSI) members for review and comments before the commencement of any practices (Kollef, 2012).
Ventilator associated pneumonia (VAP) has remained a significant issue in the medical setting with very high mortality, morbidity, and extra costs to the hospitals and patients at large. Analyzing this condition is important in the provision and implementation of preventive measures in respect to the care given to mechanically ventilated patients. It is one of the leading causes of mortality in hospitals because of nosocomial infections, and, hence, it has a greater effect on morbidity of people hospitalized in ICU. There exists a significant correlation between complications in patients under mechanical ventilation and ventilator-associated pneumonia (Valencia & Torres, 2009).
Ventilator- associated pneumonia (VAP) has been associated with increased health care cost in that it is the second largest after urinary infections, hence, keeping patients long in the hospital. Considering the costs to the hospital, VAP is attributed to excess of stay, mortality, and ICU utilization in respect to bed cost, physical costs, and antibiotic cost (Sedwick, Lance-Smith, & Nardi, 2012). VAP, having contributed to patients’ death in the hospital than other hospital-acquired infections, and being a complication that is associated with mechanical ventilation, requires concrete preventive strategies. The basic strategies in reducing its prevalence include implementation of recommendations that can reduce microbial colonization, staff education, and preventing microbial aspiration (Kollef, 2012).
To reduce ventilator- associated pneumonia in ICU, there should be changes in staff behavior. Education reinforcement is paramount on the path of the staff, hence, practicing best programs that will lead to a reduction of aspiration and oropharyngeal colonization. In line with health care policies, staff should be competent and trained in any care process and sated health procedures (Valencia & Torres, 2009).
This type of nonsocomial pneumonia, VAP, requires a very delicate approach in handling and caring for critically ill clients, with their safety coming as a priority. The American Association of Critical Care Nurses (AACN) has managed to establish some mechanisms critical to handing VAP conditions
Implementation Description
Develop a learning module for nurses on a ventilator bundle for the prevention of ventilator-associated pneumonia (VAP). Data will be collected from the nursing s...