NURS 362 Research Critique Form

In evidence based practice the literature is not only critiqued, it is graded.

Author: Mary Beth Sedwick, Mary Lance-Smith, Sara J. reeder, Jessica Nardi

Title: Using Evidence-based to Prevent Ventilator-Associated Pneumonia

Citation:

Sedwick, M. B., Lance-Smith, M., Reeder, S. J., & Nardi, J. (2012). Using Evidence-Based Practice to

Prevent Ventilator-Associated Pneumonia. Critical Care Nurse, 32(4), 41-51. doi:10.4037/ccn2012964

Study Question: (What is being studied?)

Ventilator bundle and care practices for nurses in critical care units to reduce the rate of ventilator-associated

pneumonia.

Study Design: (See glossary and other resources for types)

The ventilator bundle developed by the Institute for Healthcare Improvement was expanded to include protocols for

mouth care and hand washing, head-of-bed alarms, subglottic suctioning, and use of an electronic compliance

feedback tool. Compliance audits were used to provide immediate electronic feedback.

Sampling: (What was the sample size and how were participants selected?)

The sample size included patients in the ICU (United States) who were on ventilators and acquired VAP (ventilator

acquired pneumonia). There is a interdiscipilnary team working together to reduce the number of VAPs by using

implementing the VAP bundle project.

Data Collection: (What were the data collection strategies-i.e. interview, observation, field note, etc?)

Data collection was done by auditors: a total of 4709 ventilator days were audited for the project from January 2009

through December 2009. In a 38-month study in a surgical ICU, Bird et al compared VAP rates before and after

initiation of the IHI bundle. Before use of the bundle, the VAP rate was 10.2 cases per 1000 ventilator days. During

the study period, the rate decreased to 3.4 cases per 1000 ventilator days.

Findings: (What were the results of the study?)

Adherence to practices included in the bundle increased. Compliance rates were greater than 98% for prophylaxis

for peptic ulcer disease and deep-vein thrombosis, interruption of sedation, and elevation of the head of the bed. The

compliance rate for the oral care protocol increased from 76% to 96.8%. Readiness for extubation reached at least
92.4%. Rates of ventilator-associated pneumonia decreased from 9.47 to 1.9 cases per 1000 ventilator days. The

decrease in rates produced an estimated savings of approximately $1.5 million.

Limitations: What does the author state as limitations? What other limitations do you see?

The authors believed that the implementation of bundled practices contributed to a reduction of the VAP rates.

However, nurses need to be consistently apprised of patient safety issues and provided with the support to deliver

high-quality care. The feedback tool, use of the electronic medical record, and other strategies can be developed to

address staff performance and other quality issues. Some other limitations I see are having the interdiscipilnary team

being willing to follow through and share the responsibilities of the bundle project. If all the team members arent

participating then the results will be different.

Level of Evidence Description Articles

Reviewed
I Meta-analysis
II Experimental design/Randomized Control Trial
III Quasi-experimental design
IV Case controlled, cohort studies, longitudinal studies
V Correlation studies
VI Descriptive studies including surveys, cross sectional design,
developmental design, and qualitative studies
VII Authority opinion or expert committee reports
Other Performance improvement, review of literature

Internal Validity: Indicate which category of internal validity applies to the study____

Good (meets all the criteria for the study design)

Fair (does not meet all criteria but is judged to have no fatal flaw that invalidates the results)
Poor (contains fatal flaw)

General Comments:

This article shows that even the smallest tasks can prevent major complications for patients and that health care team
members should all be conscientious in practicing the VAP bundle.

Applicability to Practice:

I feel that as a nurse, it is our responsibility to make sure our patients receive quality care regardless of where they
are admitted to. By paying attention to detailed aspects of patient are, we would be able to minimize the number of
HAIs (hospital acquired infections). Something as simple as brushing a patients teeth can minimize the risk of many
infections and reduce the cost of health care.

Three Key Points:

- The results confirm that nurses can improve patients outcomes through the use of evidence-based practices.
- Accountability for daily patient care is a key component to improving patients outcomes.
- Nurses and other health-care professionals can use this project as a template for addressing other quality projects,
such as pressure ulcers, falls, and bloodstream infections.