Implementation of Clinical Practice Guidelines for Ventilator-Associated Pneumonia

Abstract

A 2-yr multifaceted intervention to enhance ventilator-associated pneumonia guideline uptake was associated with a significant increase in guideline concordance and a reduction in ventilator-associated pneumonia rates.

Ventilator-associated pneumonia: present understanding and ongoing debates

“…Despite several behavior modification strategies, including the use of nurse and medical champions, teaching materials, education sessions, bedside cues, and feedback about compliance, the overall bundle compliance rate was 70 % in this study. In another multicenter study, involving 1,320 patients, investigators used a 2-year multifaceted intervention via educational sessions, supplemented with reminders and local opinion leaders, to improve concordance with VAP prevention and treatment guidelines [83]. Over time, there was more improvement in prevention strategies than in therapy approaches, and overall, a significant increase in guideline concordance [aggregate concordance (mean [SD]), 50.7 % (6.1), 54.4 % (7.1), 56.2 % (5.9), 58.7 % (6.7) p = 0.007, in three consecutive 6-month periods].…”

Should Ventilator-Associated Events become a Quality Indicator for ICUs?

“…34,35 Interventional studies have helped to affirm that improvements in practice can lower both VAE rates and mean duration of mechanical ventilation. Muscedere and colleagues 26,36 assessed the impact of a 2-y educational program to increase the adoption of clinical practice guidelines for ventilated subjects in 11 ICUs in Canada and the United States. They achieved relatively modest improvements in the frequency of guideline concordant practices, yet the investigators were still able to detect a significant decrease in VAEs from 13.6% of subjects sampled at baseline to 9.7% of subjects sampled at the end of the study (P ϭ .05).…”

A multifaceted intervention to improve sepsis management in general hospital wards with evaluation using segmented regression of interrupted time series

“…Equivalent analysis of our study findings would have labelled the 9% change in our primary outcome measure as an intervention effect. A recent multifaceted intervention implemented in eleven ICUs to improve adherence to ventilator-associated pneumonia prevention guidelines, reported an overall 8% (95% CI 2.7 to 13.3%) increase in guideline adherence from 50.7% to 58.7% over a 2-year period, despite repeated intervention exposure and reported staff awareness of the recommendations 22. The article and accompanying editorial acknowledge the modest change but report it as an intervention effect 22 23.…”