Sample Nursing Paper on Ventilator-associated pneumonia (VAP)

Project Implementation Plan and Logic Model

Project Title: A Project to Reduce Ventilator-Associated Pneumonia in a Long-Term Care Facility

PICO Question

For patients in LTC facilities requiring intubation care (P), does the implementation of the ventilator care bundle (I), compared to invasive mechanical ventilation (C), reduce the VAP rate to below 6 % (O) within 12 weeks (T)?

Project Description

This project is a study that uses an evidence-based VAP bundle to help reduce the incidence rate of VAP in a long-term care facility. The VAP bundle interventions, including daily oral care with chlorhexidine for mechanically ventilated patients, HOB elevation by between 30 and 45 degrees, and assessing the patient’s readiness to wean off the ventilators (Mezidi & Guérin, 2018). The other two interventions include proper hand hygiene and minimizing the manipulation of the ventilator circuit, as well as draining the condensate fluid that causes contamination (Lucchini et al., 2020; Shah et al., 2021). The study will involve all the patients in the 24-bed ventilator unit, the RTs, and other staff members that attended to the patients. The project will be implemented for ten weeks, whereby each staff will undergo VAP care bundle education through handed out power points and observational audits done by the RN in charge of infection control as well as random checks throughout the implementation period by the RTs.

Kurt’s Lewin Change theory outlines three stages of implementing change employed for this project

The guidelines for the unfreezing step are as follows:

  • Create awareness among the facilities staff members concerning the nature and purpose of the project
  • Introduce the management to the project
  • The nursing staff and RTs fill out a pre-education survey concerning their awareness and implementation of interventions in the VAP bundle.
  • Educate the staff by introducing them to the project and giving them power points with information about the VAP care bundle
  • Collect the pre-implementation VAP rates from the infection control department for later comparison at the end of the project
  • Each staff member’s role is explained, particularly the RTs who head the VAP prevention bundle implementation and the RN who conducts the audits.
  • The project implementation is in motion after the staff review and understands the information in the power points concerning the VAP bundles, and everyone knows their role

The guidelines for the changing step are:

  • The RTs review the implementation of the intervention focusing on the following:
  • Random check of the HOB elevation to ensure it is 30-45 degrees (Güner & Kutlutürkan, 2022)
  • Confirm that nurses regularly used dots to indicate this compliance
  • Daily assessments in collaboration with the nurses to ensure patients who can wean are assessed daily
  • Checking that the ventilator circuit change is initialed after 60 days
  • The RN in charge of infection control chooses five random times during the implementation period to assess the staff’s compliance with oral chlorhexidine rinse daily for the patients
  • Lead RN chooses five random times during the implantation period to assess the staff’s hand hygiene practices.

The guidelines for the refreezing step are as follows:

  • Observational audits are presented in a bar graph to offer feedback
  • Post-implementation surveys
  • Feedback on the success of the project ad whether the below 6% VAP rate has been achieved