Abstract
Purpose: The purpose of this quality improvement project is to decrease the incidence of VAP in patients in an adult trauma intensive care unit.|Objectives: The objectives for the reader are to: (1) identify nursing barriers for VAP bundle compliance and charting; (2) determine if an increase in RN education will lead to an increase in compliance of VAP bundle components and charting; and (3) determine if an increase in education will lead to a decrease in VAP rates.|Background: Ventilator acquired pneumonia results from microaspiration of colonized secretions and usually occurs within the first 48 hours of intubation (O’Keefe-McCarthy, 2006). VAP prolongs mechanical ventilation by four days, increases critical care days by four days, and hospital length of stay by nine days (CCN, 2016). As a result of VAP, there is an increase in hospitalization costs to the patient by up to $40,000 or $1.2 billion annually in the United States (American Association of Critical Care Nurses [AACN], 2016).|Sample/Setting: The setting was a level 1 Trauma Center located in the Midwest. The sample will pertain to adult ICU patients that are admitted under a full or limited activation of the trauma team and are either intubated prior to arrival or intubated within 24 hours of admission to the trauma ICU.|Methods: The design of this project was a retrospective chart review as well as a pre and post education survey.|Results: Pre education survey found the top three barriers to VAP bundle completion were; patient injuries (40%), incomplete health provider orders (44%), and lack of knowledge (8%). Top three barriers to charting compliance; RN oversight (56%), do not know where to chart (20%), and time constraints (12%). Post education survey found the top three barriers to VAP completion; incomplete MD orders (46%), time constraints (20%), and lack of knowledge (13%). Top three barriers to charting compliance; oversight (53%), don’t know where to chart (13%), and time constraints (20%). Sixty eight percent of nurses pre-survey reported that they consistently charted the VAP bundles, while 73% reported charting consistently post survey. Pre and post survey reported that 100% of nurses believed that VAP bundles were effective when performed correctly. There were zero reported cases of VAP prior to education and survey and one reported case of VAP post education and survey.