NR 716 Week 1 Discussion

Student Name

Chamberlain University

NR-716: Analytic Methods

Prof. Name

Date

Appendix A

Johns Hopkins Individual Evidence Summary Tool
© The Johns Hopkins Hospital/The Johns Hopkins University

EBP Project Practice Question

Assessment of knowledge and implementation practices of the ventilator-associated pneumonia (VAP) bundle in the intensive care unit of a private hospital

Reviewer Information

• Reviewer Name(s): Not specified
• Article Number: 1

Evidence Summary

The study by Abad, Formalejo, and Mantaring (2021) evaluated the awareness and adherence to the ventilator-associated pneumonia (VAP) bundle within intensive care units (ICUs) across a private hospital. The researchers sought to understand how well nurses and infection control practitioners (ICPs) applied evidence-based strategies to reduce VAP incidence. The VAP bundle, as recommended by the Institute of Healthcare Improvement (IHI), included multiple components such as head-of-bed elevation, daily readiness to extubate, oral care, subglottic suctioning, and prophylaxis for deep vein thrombosis (DVT).

Although the majority of participants demonstrated awareness of the VAP bundle, overall compliance was modest. Specific gaps were identified in adherence to readiness-to-extubate assessments, while head-of-bed elevation showed the highest compliance. The authors emphasized the importance of ongoing education, training workshops, and incentive-based retention strategies for nurses to sustain consistent implementation of VAP care practices.

Evidence Table

Author, Date, and Title	Type of Evidence	Population, Size, and Setting	Intervention	Findings that Help Answer the EBP Question	Measures Used	Limitations	Evidence Level & Quality	Notes to Team
Abad, C. L., Formalejo, C. P., & Mantaring, D. M. L. (2021). Assessment of knowledge and implementation practices of the ventilator acquired pneumonia (VAP) bundle in the intensive care unit of a private hospital. Antimicrobial Resistance & Infection Control, 10(1), 161. https://doi.org/10.1186/s13756-021-01027-1	Descriptive study using both qualitative and quantitative data	60 participants (56 ICU nurses and 4 ICPs) across nationwide ICUs	VAP bundle consisting of: – Head-of-bed elevation (30°–45°) – Closed suctioning and subglottic drainage – Daily readiness-to-extubate assessments – Oral hygiene – DVT prophylaxis	– Awareness of VAP bundle present among staff, but compliance varied. – Knowledge gaps in guideline details persisted. – Highest compliance: head-of-bed elevation. – Lowest compliance: readiness-to-extubate. – Median bundle compliance was 84.6%. – Education and training essential for improving knowledge. – Nurse retention strategies critical to sustain practices.	Surveys, group discussions, and direct observation (16 events observed over three non-consecutive days during day shifts)	– Non-randomized design. – Differences in ICU settings could influence results. – Possibility of external confounders. – BPA (Best Practice Alert) did not trigger in ~28% of encounters due to system lockouts.	Level III, Good quality	Reinforce ongoing education and competency training. Retention incentives for nurses recommended to sustain adherence.

Key Insights

1. Compliance Patterns:
   While staff demonstrated good knowledge of the VAP bundle, consistent application was lacking. Readiness-to-extubate was identified as the weakest compliance area.
2. Educational Needs:
   Regular workshops, refresher training, and competency checks should be implemented to enhance staff performance.
3. Retention Challenges:
   High nurse turnover impacts long-term adherence to hospital-specific initiatives like VAP bundles. Incentive strategies may help mitigate this issue.

References

Abad, C. L., Formalejo, C. P., & Mantaring, D. M. L. (2021). Assessment of knowledge and implementation practices of the ventilator acquired pneumonia (VAP) bundle in the intensive care unit of a private hospital. Antimicrobial Resistance & Infection Control, 10(1), 161. https://doi.org/10.1186/s13756-021-01027-1

NR 716 Week 1 Discussion