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RES221
Bundling of Nursing Interventions - Ventilator Associated Pneumonia
By: Linda J. Curtin
For further information, please contact: Linda.J.Curtin@caritaschristi.org
Purpose: This study was conducted to evaluate the effect of implementing the bundling of nursing interventions on reducing Ventilator Associated Pneumonia (VAP).
Background/Significance: : Lowering the incidence of hospital-acquired infections is a national patient safety priority. Although bundling of patient safety initiatives have been studied, very little is known about how nurse-sensitive performance measures can be used to monitor safe practices and to produce improved patient outcomes. The bundled intervention specific for this study was maintenance of endotracheal cuff pressure, head of bed elevation and providing mouth care.
Methods: A comparison of individually represented and a bundled autonomous nursing intervention was undertaken. Survival analysis using the Weibull Parameterization Proportional Hazard Model was utilized to estimate the likelihood of developing a VAP. An aim of the study was to give insight into the patient’s risk process that leads to the development of a VAP and to gain insight into how the risk changes over time, after intubation. Multivariate analysis focused on the comparison between bundled nursing and individually represented nursing interventions in reducing the patient’s risk for developing a VAP.
Results: The optimal nursing intervention bundle consisted of the bundling of endotracheal tube cuff pressure between 20 to 25 cm H20, head of bed elevation between 30 to 45 degrees and mouth care provided every two or every four hours. The risk of developing a VAP was about 97.6% lower (p = .004) among patients who received the bundling of nursing interventions; relative to those who did not receive this bundle of services. And the expected time until a VAP occurred was estimated to be almost 3.5 times longer (p = .003) among patients receiving the optimal bundle intervention relative to those who did not receive the optimal nursing bundle intervention.
Conclusions: Bundling of 3 autonomous nursing interventions achieved a better patient outcome than if these same autonomous interventions were implemented individually.
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