Improving Oral Care in Patients Receiving Mechanical Ventilation

2005 ◽  
Vol 14 (5) ◽  
pp. 389-394 ◽  
Author(s):  
Constance J. Cutler ◽  
Nancy Davis
Keyword(s):  
Mechanical Ventilation ◽  
Best Practice ◽  
Current Practice ◽  
Oral Care ◽  
Implementation Strategies ◽  
Baseline Period ◽  
Evidence Based ◽  
Oral Secretions ◽  
Mucosal Tissues ◽  
Care Practices

• Background Comprehensive oral care is an evidence-based prevention strategy to reduce the risk of ventilator-associated pneumonia in patients receiving mechanical ventilation. Until recently, no comprehensive guidelines or standards existed to define necessary tasks, methods, and frequency of oral care to provide patients with optimal results. • Objectives To observe current practice of, define best practice for, and measure compliance with standardized comprehensive oral care. • Methods This observational study was part of a larger research study performed at 5 acute care hospitals. Time blocks of 4 hours were randomized over 8 intensive care units and the 7 days of the week. Baseline data were collected before implementation of multifaceted education on an oral-cleansing protocol; interventional data were collected afterward. • Results Oral care practices were observed for 253 patients. During the baseline period, oral cleansing was primarily via suction swabs. Toothbrushing and moisturizing of the oral tissues were not observed. Only 32% of the patients had suctioning to manage oral secretions. During the interventional period, 33% of patients had their teeth brushed, 65% had swab cleansing, and 63% had a moisturizer applied to the oral mucosal tissues. A total of 61% had management of oral secretions; 38% had oropharyngeal suctioning via a special catheter. • Conclusions Implementation of an evidence-based oral cleansing protocol improved the care of patients receiving mechanical ventilation. Multifaceted education and implementation strategies motivated staff to increase oral care practices.

Giving Voice: Nurse-Patient Communication in the Intensive Care Unit

2021 ◽  
Vol 30 (4) ◽  
pp. 256-265
Author(s):  
Mary Beth Happ
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Best Practice ◽  
Patient Communication ◽  
Evidence Based ◽  
Patient Relationship ◽  
Communication Partner ◽  
Seriously Ill Patients ◽  
Tools And Techniques ◽  
Seriously Ill

Communication is the essence of the nurse-patient relationship. The critical care nurse’s role in facilitating patient communication and enabling communication between patients and their families has never been more important or poignant than during the COVID-19 pandemic. We have witnessed tremendous examples of resourceful, caring nurses serving as the primary communication partner and support for isolated seriously ill patients during this pandemic. However, evidence-based tools and techniques for assisting awake, communication-impaired, seriously ill patients to communicate are not yet systematically applied across all settings. Missed communication or misinterpretation of patients’ messages induces panic and fear in patients receiving mechanical ventilation and can have serious deleterious consequences. This lecture presents a 23-year program of research in developing and testing combination interventions (eg, training, tailored assessment, and tools) for best practice in facilitating patient communication during critical illness. Evidence from related nursing and inter pro fessional research is also included. Guidance for unit-based assessment, tailoring, and implementation of evidence-based patient communication protocols also is provided.

Abstract WP400: Simulation Training is a Feasible Implementation Strategy for Evidence Based Stroke Swallowing Screening

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Karen Stonecypher ◽  
Racquell Garrett ◽  
Barbara Kimmel ◽  
Stephanie Daniels ◽  
Jane Anderson
Keyword(s):  
Nursing Staff ◽  
Best Practice ◽  
Simulation Training ◽  
Quality Care ◽  
Video Clip ◽  
Implementation Strategies ◽  
Oral Intake ◽  
Evidence Based ◽  
Train The Trainer ◽  
Swallowing Screening

Backgroud and Purpose: A well-established best practice in providing safe, high quality care for patients with stroke is screening swallowing prior to oral intake. Effective implementation strategies are needed to support evidence based swallowing screening. The use of simulation is now being widely used to train healthcare professionals in evidence based practices. The purpose of this project was to assess the feasibility of simulation training modules (STMs) to support delivery of evidence based swallowing screening with frontline emergency department (ED) nurses. Methods: A train-the-trainer approach was used with (n=8) nurse champions who received didactic instruction and training with video clips and medical mannequins programmed to simulate auditory elements of stroke swallowing screening. After demonstration of mastery, each nurse champion then trained their peers using the same format. Feasibility for implementation of the STMs was evaluated through process mapping. Acquisition of skills was evaluated with a competency checklist and medical mannequins simulated with various stroke patient profiles. Knowledge was assessed using a pre/posttest. Results: A portable simulation lab was set up in the ED and nurse champions trained 100% of nursing staff over a two-month period. A total of 16 simulation sessions were needed to train all nursing staff (N=42). Didactic and video clip review was completed in 45-minute group sessions followed by 30-minute simulation practice sessions. Competency and knowledge was assessed 2-weeks after completing STMs. Competency checkoff sessions were completed in approximately 15-minutes. There was a significant increase in nurses’ knowledge and skills from baseline to posttest. Conclusions: It is feasible to implement STMs with frontline ED nurses. The STMs were beneficial for training and acquisition of skills in a controlled environment with a variety of patient examples. Repeated practice is critical to develop the auditory perceptual skills necessary for swallowing screening interpretation. STMs can be used in the ED for nurses to independently practice and improve swallowing screening skills.

Preventing Ventilator-Associated Pneumonia Through Oral Care, Product Selection, and Application Method

2013 ◽  
Vol 24 (1) ◽  
pp. 38-58 ◽  
Author(s):  
Bianca Hillier ◽  
Christine Wilson ◽  
Di Chamberlain ◽  
Lindy King
Keyword(s):  
Mechanical Ventilation ◽  
Oral Hygiene ◽  
Best Practice ◽  
Oral Care ◽  
Nurse Education ◽  
Future Research ◽  
Ventilator Associated Pneumonia ◽  
Care Product ◽  
Care Protocol ◽  
Application Techniques

Objective: Review the literature to identify the most effective method of oral hygiene to reduce the incidence of ventilator-associated pneumonia (VAP). Background: Ventilator-associated pneumonia is the most common nosocomial infection in patients being treated with mechanical ventilation. Method: This study is a systematic literature review. The databases searched included Web of Science, Cumulative Index to Nursing and Allied Health Literature, Ovid, and MEDLINE. Results: Implementation of oral care protocols and nurse education programs reduced VAP. Although chlorhexidine was the most popular oral care product, no consensus emerged on concentration or protocols for oral care. Conclusion: No consensus on best practice for oral hygiene in patients being treated with mechanical ventilation was found. Chlorhexidine was the most popular oral care product. Implementation of an oral care protocol, ongoing nurse education, and evaluation were important in reducing the incidence of VAP. Future research should analyze chlorhexidine concentration, application techniques, and frequency of oral care, to optimize VAP prevention.

scholarly journals Review of implementation strategies to change healthcare provider behaviour in the emergency department

CJEM ◽  
2018 ◽  
Vol 20 (3) ◽  
pp. 453-460 ◽  
Author(s):  
Kerstin de Wit ◽  
Janet Curran ◽  
Brent Thoma ◽  
Shawn Dowling ◽  
Eddy Lang ◽  
...  
Keyword(s):  
Emergency Department ◽  
Implementation Research ◽  
Best Practice ◽  
Clinical Care ◽  
Intervention Strategy ◽  
Implementation Strategies ◽  
Evidence Based ◽  
Medicine Research ◽  
Canadian Association ◽  
New Evidence

AbstractObjectivesAdvances in emergency medicine research can be slow to make their way into clinical care, and implementing a new evidence-based intervention can be challenging in the emergency department. The Canadian Association of Emergency Physicians (CAEP) Knowledge Translation Symposium working group set out to produce recommendations for best practice in the implementation of a new science in Canadian emergency departments.MethodsA systematic review of implementation strategies to change health care provider behaviour in the emergency department was conducted simultaneously with a national survey of emergency physician experience. We summarized our findings into a list of draft recommendations that were presented at the national CAEP Conference 2017 and further refined based on feedback through social media strategies.ResultsWe produced 10 recommendations for implementing new evidence-based interventions in the emergency department, which cover identifying a practice gap, evaluating the evidence, planning the intervention strategy, monitoring, providing feedback during implementation, and desired qualities of future implementation research.ConclusionsWe present recommendations to guide future emergency department implementation initiatives. There is a need for robust and well-designed implementation research to guide future emergency department implementation initiatives.

scholarly journals Stakeholder Education for Community-Wide Health Initiatives: A Focus on Teen Pregnancy Prevention

2017 ◽  
Vol 19 (1) ◽  
pp. 38-50 ◽  
Author(s):  
Cara Finley ◽  
Katherine Suellentrop ◽  
Rebecca Griesse ◽  
Lawrence Duane House ◽  
Anna Brittain
Keyword(s):  
Public Health ◽  
Teen Pregnancy ◽  
Best Practice ◽  
Implementation Strategies ◽  
Future Research ◽  
Evidence Based ◽  
Teen Pregnancy Prevention ◽  
Local Stakeholder ◽  
Health Initiatives ◽  
Stakeholder Needs

Teen pregnancies and births continue to decline due in part to implementation of evidence-based interventions and clinical strategies. While local stakeholder education is also thought to be critical to this success, little is known about what types of strategies work best to engage stakeholders. With the goal of identifying and describing evidence-based or best practice strategies for stakeholder education in community-based public health initiatives, we conducted a systematic literature review of strategies used for effective stakeholder education. Over 400 articles were initially retrieved; 59 articles met inclusion criteria. Strategies were grouped into four steps that communities can use to support stakeholder education efforts: identify stakeholder needs and resources, develop a plan, develop tailored and compelling messaging, and use implementation strategies. These strategies lay a framework for high-quality stakeholder education. In future research, it is important to prioritize evaluating specific activities taken to raise awareness, educate, and engage a community in community-wide public health efforts.

Meeting the Best Practice for Hearing Aid Verification in Children: Challenges and Future Directions

2019 ◽  
Vol 28 (4) ◽  
pp. 877-894
Author(s):  
Nur Azyani Amri ◽  
Tian Kar Quar ◽  
Foong Yen Chong
Keyword(s):  
Clinical Practice ◽  
Hearing Aids ◽  
Best Practice ◽  
Hearing Aid ◽  
Evidence Based ◽  
Future Directions ◽  
Major Barrier ◽  
Klang Valley ◽  
Age Range ◽  
Fitting Hearing Aids

Purpose This study examined the current pediatric amplification practice with an emphasis on hearing aid verification using probe microphone measurement (PMM), among audiologists in Klang Valley, Malaysia. Frequency of practice, access to PMM system, practiced protocols, barriers, and perception toward the benefits of PMM were identified through a survey. Method A questionnaire was distributed to and filled in by the audiologists who provided pediatric amplification service in Klang Valley, Malaysia. One hundred eight ( N = 108) audiologists, composed of 90.3% women and 9.7% men (age range: 23–48 years), participated in the survey. Results PMM was not a clinical routine practiced by a majority of the audiologists, despite its recognition as the best clinical practice that should be incorporated into protocols for fitting hearing aids in children. Variations in practice existed warranting further steps to improve the current practice for children with hearing impairment. The lack of access to PMM equipment was 1 major barrier for the audiologists to practice real-ear verification. Practitioners' characteristics such as time constraints, low confidence, and knowledge levels were also identified as barriers that impede the uptake of the evidence-based practice. Conclusions The implementation of PMM in clinical practice remains a challenge to the audiology profession. A knowledge-transfer approach that takes into consideration the barriers and involves effective collaboration or engagement between the knowledge providers and potential stakeholders is required to promote the clinical application of evidence-based best practice.

Tailored interventions to support the implementation of the German national guideline on screening, diagnosis and treatment of alcohol-related disorders: a project protocol

2019 ◽  
Vol 65 (6) ◽  
pp. 373-381 ◽  
Author(s):  
Bernd Schulte ◽  
Christina Lindemann ◽  
Angela Buchholz ◽  
Anke Rosahl ◽  
Martin Härter ◽  
...  
Keyword(s):  
Alcohol Use ◽  
Guideline Implementation ◽  
Implementation Strategies ◽  
Organizational Factors ◽  
Diagnosis And Treatment ◽  
Primary Data ◽  
Routine Practice ◽  
Evidence Based ◽  
Advisory Boards ◽  
Prevention And Treatment

Abstract. Background: The German Guideline on Screening, Diagnosis and Treatment of Alcohol Use Disorders aims to increase the uptake of evidence-based interventions for the early identification, diagnosis, prevention and treatment of alcohol-related disorders in relevant healthcare settings. To date, dissemination has not been accompanied by a guideline implementation strategy. The aim of this study is to develop tailored guideline implementation strategies and to field-test these in relevant medical and psycho-social settings in the city of Bremen, Germany. Methods: The study will conduct an impact and needs assessment of healthcare provision for alcohol use orders in Bremen, drawing on a range of secondary and primary data to: evaluate existing healthcare services; model the potential impact of improved care on public health outcomes; and identify potential barriers and facilitators to implementing evidence-based guidelines. Community advisory boards will be established for the selection of single-component or multi-faceted guideline implementation strategies. The tailoring approach considers guideline, provider and organizational factors shaping implementation. In field tests quality outcome indicators of the delivery of evidence-based interventions will be evaluated accompanied by a process evaluation to examine patient, provider and organizational factors. Outlook: This project will support the translation of guideline recommendations for the identification, prevention and treatment of AUD in routine practice and therefore contributes to the reduction of alcohol-related burden in Germany. The project is running since October 2017 and will provide its main outcomes by end of 2020. Project results will be published in scientific journals and presented at national and international conferences.

The use of the objective structured clinical examination (OSCE) in a practice-based health discipline: Academic and student experience in paramedicine

2020 ◽  
Vol 3 (2) ◽  
Author(s):  
Andy Bell ◽  
Jennifer Kelly ◽  
Peter Lewis
Keyword(s):  
Clinical Examination ◽  
Best Practice ◽  
Assessment Tool ◽  
Clinical Performance ◽  
Reliability And Validity ◽  
Specific Area ◽  
Training Model ◽  
Objective Structured Clinical Examination ◽  
Evidence Based ◽  
Effective Measure

Abstract:Purpose:Over the past two decades, the discipline of Paramedicine has seen expediential growth as it moved from a work-based training model to that of an autonomous profession grounded in academia.  With limited evidence-based literature examining assessment in paramedicine, this paper aims to describe student and academic views on the preference for OSCE as an assessment modality, the sufficiency of pre-OSCE instruction, and whether or not OSCE performance is a perceived indicator of clinical performance.Design/Methods:A voluntary, anonymous survey was conducted to examine the perception of the reliability and validity of the Objective Structured Clinical Examination (OSCE) as an assessment tool by students sitting the examination and the academics that facilitate the assessment. Findings:The results of this study revealed that the more confident the students are in the reliability and validity of the assessment, the more likely they are to perceive the assessment as an effective measure of their clinical performance.  The perception of reliability and validity differs when acted upon by additional variables, with the level of anxiety associated with the assessment and the adequacy of feedback of performance cited as major influencers. Research Implications:The findings from this study indicate the need for further paramedicine discipline specific research into assessment methodologies to determine best practice models for high quality assessment.Practical Implications:The development of evidence based best practice guidelines for the assessment of student paramedics should be of the upmost importance to a young, developing profession such as paramedicine.Originality/Value: There is very little research in the discipline specific area of assessment for paramedicine and discipline specific education research is essential for professional growth.Limitations:The principal researcher was a faculty member of one of the institutions surveyed.  However, all data was non identifiable at time of data collection.  Key WordsParamedic; paramedicine; objective structured clinical examinations; OSCE; education; assessment.

Implementation Strategies

2017 ◽  
Author(s):  
JoAnn E. Kirchner ◽  
Thomas J. Waltz ◽  
Byron J. Powell ◽  
Jeffrey L. Smith ◽  
Enola K. Proctor
Keyword(s):  
Implementation Science ◽  
Comparative Effectiveness ◽  
Implementation Strategies ◽  
Evidence Based ◽  
Efficient Manner

As the field of implementation science moves beyond studying barriers to and facilitators of implementation to the comparative effectiveness of different strategies, it is essential that we create a common taxonomy to define the strategies that we study. Similarly, we must clearly document the implementation strategies that are applied, the factors that influence their selection, and any adaptation of the strategy during the course of implementation and sustainment of the innovation being implemented. By incorporating this type of rigor into our work we will be able to not only advance the science of implementation but also our ability to place evidence-based innovations into the hands of practitioners in a timely and efficient manner.

scholarly journals Oral Candidiasis and COVID-19 in Users of Removable Dentures: Is Special Oral Care Needed?

Gerontology ◽  
2021 ◽  
pp. 1-6
Author(s):  
Laura Silva Jerônimo ◽  
Rafael Paschoal Esteves Lima ◽  
Thaís Yumi Umeda Suzuki ◽  
José Augusto César Discacciati ◽  
Cláudia Lopes Brilhante Bhering
Keyword(s):  
Mechanical Ventilation ◽  
Candida Albicans ◽  
Oral Health ◽  
Early Diagnosis ◽  
Elderly Patients ◽  
Oral Candidiasis ◽  
Oral Care ◽  
Antifungal Treatment ◽  
Immunocompromised Patients ◽  
Appropriate Care

Elderly patients with systemic disorders and immunocompromised patients seem to have a higher risk of developing morbidity from COVID-19. <i>Candida albicans</i> (<i>C. albicans</i>) is a potentially dangerous pathogen for these patients, especially for denture wearers with prosthetic stomatitis who require mechanical ventilation. <i>C. albicans</i> infection, the main candidiasis infection associated with denture wear, can complicate COVID-19 and increase the associated morbidity and mortality. Therefore, early diagnosis of <i>C. albicans</i> infection in COVID-19 patients is important to establish more effective antifungal treatment methods and prophylaxis strategies. Hospitalized COVID-19 patients should undergo an oral examination to assess their oral health, and those with poor oral health should receive the appropriate care and monitoring.

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