Results from development of clinical nursing practice guidelines for patients with ventilation mechanical in intensive care unit in Loei hospital

Abstract

Patients with respiratory failure who need ventilator support increase the risk of respiratory complication. In 2017, patients in the Intensive Care Unit (ICU), Loei hospital, there are 692 patients and 610 Patients (88.4%) were on ventilator support. The incidents rate of endotracheal tube (ETT) dislodgement rate was 4.5: 1000 ventilator days; the ventilator- associated pneumonia was 8.3: 1000 ventilator days. The causes were that the nurses lacked knowledge, skill and experiences and the nursing clinical practice guideline for a patient with a ventilator was not standard and inappropriate with patient’s problem and technology of ventilator. Therefore, we use action research for the development of nursing clinical practice guideline for a patient with a ventilator in ICU, Loei hospital. There were three cycles with four steps as follows: planning, action, observation and reflection, to give the data feedback to nurses and analyze for improvement in next cycle. The first cycle, there were six parts of nursing clinical practice guideline including 1) Adequated oxygenation. 2) Airway clearance. 3) Daily activity care (as mouth care, etc.). 4) Prevention ventilator complications. 5) Tracheal injury from endotracheal tube prevention. 6) Controlling the ventilator machine. The second cycle was to develop six guidelines of ventilator caring and developed one practice that decrease the anxiety of the patients with weaning from the ventilators. 

The finding found that nursing practice guideline for patients with ventilation mechanical nursing promoted nursing care at .01 (P<.01) significantly statistic (Friedman, Mean Rank as 1.71, 2.47, 2.91 and 2.91 respectively). These results decreased the rate of ventilator-associated pneumonia from 14.00 to 11.34 : 1000 ventilator days. The incidents rate endotracheal tube dislocation rate decreased from 6.68 to 4.73: 1000 ventilator days. (Before and after using the nursing clinical practice guideline implementation within three months). 

Moreover, the nurses’ satisfaction with clinical practice guideline was 95%. The success key factors were all nurses participated in developing guidance. The results made nurses to understand the problems and in situation analysis, awareness, changing guideline and reflect problems. This guideline decreased complications in patients and has been developing nursing care in ICU.