A PICOT Paper on the Clinical Inquiry Concerning the Prevention Ventilator-Associated Pneumonia or VAP
Professional clinical practice as a nurse is usually defined by challenges in managing particular health issues that may not already be having effective interventions. This is because the overriding philosophy in contemporary healthcare practice is evidence-based practice or EBP. For clinical practice problems that pose a challenge because they do not have well-defined evidence-based solutions, clinical inquiry is used to find the same. Clinical inquiry uses the PICOT model (Population, Intervention, Comparison, Outcome, and Timeframe) in searching for scholarly evidence systematically (Melnyk & Fineout-Overholt, 2019). For the evidence to be valid, however, it must be from scholarly peer-reviewed and recently published research. This paper is about the clinical inquiry process to identify evidence-based interventions that provide the solution for the prevention of ventilator-associated pneumonia (VAP) in critical care units. It provides the PCOT statement to the identified clinical problem and describes the associated components in detail. PICOT Question Paper
The PICOT Question and the Evidence-Based Practice Solution or Intervention
The identified clinical problem to be addressed in this case is the development of ventilator-associated pneumonia (VAP) in mechanically-ventilated critically ill patients who have been hospitalized and ventilated for more than 48 hours. VAP is a quality improvement (QI) issue and can be used as a quality benchmark or indicator to assess for the quality of healthcare services offered in intensive care units. It is a hospital-acquired infection (HAI) and is therefore a preventable outcome. As a matter of fact, VAP is the most common HAI of all among critically-ill patients. Up to 28% of all patients on mechanical ventilation are known to be affected by VAP. Three specific consequences of VAP impact the outcomes of the patients who are mechanically ventilated (Ghezeljeh et al., 2017). VAP increases the length of their stay in intensive care and the hospital as a whole. It also as a consequence increases the cost of hospitalization of these patients as well as the mortality rate. Both of these are outcome measures that are used to evaluate care quality.
The proposed evidence-based intervention to prevent this problem of VAP is a two-pronged bundled solution comprising of daily oral care with chlorhexidine mouth wash solution and patient positioning in semi-recumbent position (Hassankhani et al., 2017; Villar et al., 2016). This is compared with the usual care with no chlorhexidine use or particular positioning requirement. It is expected that this solution will result in a statistically significant reduction of the rate of VAP in the stated patient population within a period of six months. The PICOT elements are shown in the table below, as is the PICOT statement which appears here below the table.
Table: PICOT elements related to the evidence-based prevention strategies for VAP
| P |
Population |
Adult patients who are critically ill and have been on mechanical ventilation for more than 48 hours. |
| I |
Intervention or proposed solution |
Putting the patient in semi-recumbent position and performing daily oral care with chlorhexidine mouthwash. |
| C |
Comparison or alternative solution |
The usual care of no chlorhexidine use or any particular patient position. |
| O |
Outcome |
A statistically significant reduction in the rate of VAP after the intervention. |
| T |
Time period for the intervention |
Six months of applying the two-pronged intervention bundle. |
The PICOT statement is therefore as follows: “In adult critically-ill patients mechanically ventilated for more than 48 hours (P), does the use of semi-recumbent position and performance of daily chlorhexidine oral care (I) compared to the usual care where no specific positioning or chlorhexidine mouthwash is used (C) result in the reduction of VAP rates (O) within a timeframe of six months (T)?”
The Problem as It Relates to the Evidence-Based Solution, the Nursing Intervention, Patient Care, Healthcare Agency, and Nursing Practice
The only solution that can mitigate the problem of VAP is the application of efficacious evidence-supported interventional measures that are supported by scholarly literature. In this case, these are patient positioning and oral care with chlorhexidine. Both of these are nursing interventions, a fact that makes these strategies nurse-led. Applying these VAP prevention strategies is quality patient care. That is patient care that is safe, effective, timely, efficient, equitable, and patient-centered (Tzelepis et al., 2015). Nursing practice that is premised on EBP adopts a strategy such as this in solving clinical quality problems. The scenario presented here occurs in the hospital as the healthcare agency of concern. Typically, intensive care units are to be found in big metropolitan hospitals that have a diverse array of specialist units within its structure. PICOT Question Paper
Conclusion
In conclusion, EBP is the gold standard for the provision of quality healthcare services. In the case of VAP among mechanically-ventilated critically ill patients, available evidence points to the efficacy of a two-in-one strategy. That is daily oral care with chlorhexidine solution as well as patient positioning in the semi-recumbent position. Both of these interventions are meant to occur simultaneously and to be undertaken by the critical care nurses. Essentially, the management and prevention of VAP is a nurse-led initiative that improves nursing quality indicators.
References
Ghezeljeh, T.N., Kalhor, L., Moghadam, O.M., Lahiji, M.N., & Haghani, H. (2017). The comparison of the effect of the head of bed elevation to 30 and 45 degrees on the incidence of ventilator associated pneumonia and the risk for pressure ulcers: A controlled randomized clinical trial.
Iranian Red Crescent Medical Journal, 19(7), 1-10. http://dx.doi.org/10.5812/ircmj.14224
Hassankhani, H., Akbarzadeh, S., Lakdizaji, S., Najafi, A., & Mamaghani, E.A. (2017). Effects of 60° semi-recumbent position on preventing ventilator-associated pneumonia: A single-blind prospective randomised clinical trial.
Journal of Clinical and Diagnostic Research, 11(12), 36-39. http://dx.doi.org/10.7860/JCDR/2017/27443.11007
Melnyk, B.M., & Fineout-Overholt, E. (2019).
Evidence-based practice in nursing & healthcare: A guide to best practice, 4th ed. Wolters Kluwer.
Tzelepis, F., Sanson-Fisher, R., Zucca, A., & Fradgley, E. (2015). Measuring the quality of patient-centered care: Why patient-reported measures are critical to reliable assessment.
Patient Preference and Adherence, 9, 831-835. https://doi.org/10.2147/ppa.s81975
Villar, C.C., Pannuti, C.M., Nery, D.M., Morillo, C.M., Carmona, M.J.C., & Romito, G.A. (2016). Effectiveness of intraoral chlorhexidine protocols in the prevention of ventilator-associated pneumonia: A meta-analysis and systematic review.
Respiratory Care,
61(9), 1245-1259. https://doi.org/10.4187/respcare.04610
WEEK 6 NRS 493 PICOT Question Paper
Review your problem or issue and the study materials to formulate a PICOT question for your capstone project change proposal. A PICOT question starts with a designated patient population in a particular clinical area and identifies clinical problems or issues that arise from clinical care. The intervention used to address the problem must be a nursing practice intervention. Include a comparison of the nursing intervention to a patient population not currently receiving the nursing intervention, and specify the timeframe needed to implement the change process. Formulate a PICOT question using the PICOT format (provided in the assigned readings) that addresses the clinical nursing problem.
The PICOT question will provide a framework for your capstone project change proposal.
In a paper of 500-750 words, clearly identify the clinical problem and how it can result in a positive patient outcome.
Describe the problem in the PICOT question as it relates to the following:
1. Evidence-based solution
2. Nursing intervention
3. Patient care
4. Health care agency
5. Nursing practice
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite. Refer to the Lopes
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