Effect of Implementing Evidence-based Practice and Nurse's Behavior Change on Quality of Care in Intensive Care Unit: Focus on Ventilator Associated Pneumonia in a Tertiary Hospital in Bangladesh
- Conditions
- Ventilator Associated Pneumonia (VAP)Evidence Based Practice
- Registration Number
- NCT06624540
- Lead Sponsor
- Hiroshima University
- Brief Summary
Quality of care is crucial for preventing adverse events such as infection in the intensive care units (ICUs). The most common ICU-acquired infections include pneumonia such as ventilator-associated pneumonia (VAP), Central Line Bloodstream Infection (CLABSI), catheter-associated urinary tract in, Medical Device Related Pressure Ulcer (MDRPU) and Pressure Ulcer (PU). This study explores the patient outcome in ICU by examining the causes and prevalence of ICU-acquired infection. The implementation of evidence-based practice (EBP) to reduce infection and change the nurses practice (behavioral changes) to adhere with EBP based on simulation-based training.
General objective:
To evaluate the effect of EBP by using recent technologies-based equipment to prevent VAP and promote behavior change among nurses for better outcome of the patient in ICU.
Specific Objectives:
1. To determine the incidence of adverse events (VAP rate, MDRPU rate, PU rate, CLABSI rate), length of stay and survival rate in ICU.
2. To evaluate the effectiveness of EBP education by changing nurses' behavior and determine its impact on improving patient outcomes in the ICU.
3. To evaluate the effectiveness of EBP including proper equipment use and changed nurses behavior acquired through the training for better patient outcome (VAP ratio) in the ICU.
4. To examine the feasibility of evaluation process and outcomes and successful implementation of EBP in ICU.
Hypothesis:
It is hypothesize that implementing EBP in ICU, including new equipment use and nurses training, will improve patient outcome.
These research consist of three studies:
Phase 1: Incidence of adverse events (VAP rate, MDRPU rate, PU rate, CLABSI rate), length of stay and survival rate in ICU. The patients of General ICU will be followed up after admission up to discharge or death at ICU. The investigators use the study findings for our subsequent intervention study 3 as historical data.
Phase 2: A pre- and post- quasi-experimental study will be conducted for 6 months to evaluate the nurse's competency on EBP after getting 1-month EBP training. This study has 3 steps: (1) Pre-observation period to measure nurse's competency level for 2-month, (2) nurse's EBP training period with preparation for 1 month, and (3) post-implementation period to measure nurse's competency and implementation of EBP practice for 2 months. Study nurses will receive EBP training, EBP and proper equipment for patient management. The nurses will receive EBP education and training with necessary equipment, such as a close suction catheter, an endotracheal tube, a suction device, and a mouth care brush. In this study, use global standard equipment for the patients safety.
Phase 3: A pre- and post- quasi-experimental study will be implemented to evaluate the efficacy of EBP implementation. The investigators use new equipment and implement EBP for patients and assess the patient outcomes. The investigators compare the findings from study 1 (as historical data) with the data from this study 3.
The investigators will compare the VAP infection prevalence and patients' outcomes related to ICU-acquired infection between pre- and post- test phase.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 272
- Irrespective of age and sex, participant must be 18 years old.
- Legal guardian of a patient consents to participation in the study
- Intubated patients after admission.
- Who stays less than 2 days at the GICU.
- Who dies or is extubated within 2 days after admitted in the GICU.
- ICU readmission.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SINGLE_GROUP
- Primary Outcome Measures
Name Time Method Incidence rate of ventilator-associated pneumonia (VAP) 2 months Incidence rate of VAP per 1000 ventilator days.
The nurse's skill performance is related to VAP checklist Study 2: 6 months Measured by researcher-developed nurse's skill performance VAP related 64 items checklist; total score 140- High (112 / \>80%), Moderate (70-111 / 50-80%), Low (69 / \<50%)
- Secondary Outcome Measures
Name Time Method A nurse's motivation level will be measured 6 month A nurse's motivation level will be measured by the Motivation scale. . Total 12 items, and score ranges 1 lower motivation and 10 higher motivations.
VAP episode 2 months VAP episode per 1000 ventilation day.
Mortality and morbidity rate 2 months Mortality and morbidity rate of ventilated patients in ICU
Survival rate in ICU 2 months Average survival rate of ICU
Nurses' sustained implementation measured 6 months Nurses' sustained implementation measured by Nurses sustained implementation scale. The total item is 28, and 4-point liker scale. Scores ranges from 28 (no sustainability) to 112 (good sustainability).
Nurses knowledge and practice related to VAP prevention measured. 6 months Measured by researcher modified nurses knowledge related to VAP prevention scale total 12 \& 6 items.
Interval of VAP occurrence 2 months Interval from ICU admission to VAP occurrence
Onset of VAP 2 months How many patient suffer early onset and late onset on VAP.
Length of stay ICU patients 2 months Average length of stay ICU patients.
Organizational readiness measured 6 months Organizational readiness measured by Organizational readiness scale. Total 03 items convergent validity (r = 0.42 - 0.72) for the correlations between the shortened and longer scales.
Micro-organism link to VAP 2 months After diagnosis of VAP then identify what kind organism relate to VAP.
Trial Locations
- Locations (2)
Dhaka Medical College Hospital
🇧🇩Dhaka, Bangladesh
Hiroshima University
🇯🇵Hiroshima, Kasumi 1-2-3 Minami-ku, Japan
Dhaka Medical College Hospital🇧🇩Dhaka, Bangladesh