Study of Knowledge Translation of Clinical Practice Guidelines for Ventilator Associated Pneumonia

NCT ID: NCT00434460

Last Updated: 2010-09-01

Basic Information

• Recruitment Status: COMPLETED
• Total Enrollment: 1320 participants
• Study Classification: OBSERVATIONAL
• Study Start Date: 2007-04-30
• Study Completion Date: 2010-07-31

Brief Summary

The purpose of this prospective, multicentre, time-series study is to develop, implement, refine, and evaluate a sustainable behaviour change strategy in the intensive care unit (ICU).

Detailed Description

Background:

In order to improve the care of our patients, it is necessary for research evidence to be translated into clinical practice. There are gaps in our understanding of knowledge translation (KT) and this is evident in the Intensive Care Unit (ICU), specifically as it applies to the prevention, diagnosis and treatment of ventilator-associated pneumonia (VAP). VAP is associated with a high burden of illness in the critically ill and there is an extensive amount of research evidence on this disease. It has been demonstrated that best practice as defined by research evidence is not uniformly applied to VAP. In addition, recent advances in VAP knowledge need be disseminated and implemented in order to improve patient safety and outcomes from VAP. A systematic process of knowledge transfer is crucial to translate this research into evidence-based bedside practice and the development and implementation of evidence based Clinical Practice Guidelines (CPGs) may facilitate VAP knowledge uptake. In addition, there is a need to study knowledge translation (KT) in the ICU since there is little information about optimal KT and CPG implementation strategies in this environment and efforts that are effective in other clinical areas may not result in meaningful change in the ICU.

Research Question:

What is the effect of VAP CPGs implemented by a multidisciplinary behaviour change strategy (consisting of multifaceted educational strategies led by local opinion leaders and augmented with reminders) on VAP guideline concordance and on clinical VAP outcomes in the ICU?

Research Plan:

Data will only be collected on consecutive patients mechanically ventilated for at least 48 hours. The following health care professionals will be studied to assess the behaviour change strategy for the VAP CPGs: physicians (intensivists, ICU fellows, ICU rotating residents), nurses, respiratory therapists, dieticians, physiotherapists and ICU administrators.

The study will be conducted in 3 phases:

1. Development of a behaviour change strategy consisting of three components:

• Local opinion leader team
• Educational strategy
• Reminder system

2. Prospective implementation of the behaviour change strategy over a 24 month period

3. Prospective evaluation of the behaviour change strategy over a 24 month period

• Concordance with VAP guidelines over time
• Factors associated with VAP guideline concordance
• Clinical VAP outcomes pre- and post-guideline implementation

Conditions

Ventilator Associated Pneumonia

Study Design

• Observational Model Type: COHORT
• Study Time Perspective: PROSPECTIVE

Study Groups

1

Patients receiving invasive mechanical ventilation \> 48 hours.

Education

Intervention Type: BEHAVIORAL

Implementation of clinical practice guideline for ventilator associated pneumonia through education.

Interventions

Education

Implementation of clinical practice guideline for ventilator associated pneumonia through education.

Intervention Type: BEHAVIORAL

Eligibility Criteria

Inclusion Criteria

• Age >= 17 years old
• Mechanically ventilated > 48 hours < 96 hours

Exclusion Criteria

• Previous enrollment in the study

• Minimum Eligible Age: 17 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Kingston Health Sciences Centre

OTHER

Sponsor Role: collaborator

Canadian Institutes of Health Research (CIHR)

OTHER_GOV

Sponsor Role: collaborator

AstraZeneca

INDUSTRY

Sponsor Role: collaborator

Bayer

INDUSTRY

Sponsor Role: collaborator

Canadian Critical Care Trials Group

OTHER

Sponsor Role: lead

Responsible Party

Kingston General Hospital, Queen's University

Principal Investigators

John Muscedere, MD

Role: STUDY_CHAIR

Kingston General Hospital, Queen's University

Tasmin Sinuff, MD, PhD

Role: STUDY_CHAIR

Sunnybrook Health Sciences Centre, University of Toronto

Daren Heyland, MD

Role: PRINCIPAL_INVESTIGATOR

Kingston General Hospital, Queen's University

Deborah Cook, MD

Role: PRINCIPAL_INVESTIGATOR

St. Joseph's Healthcare, McMaster University

Peter Dodek, MD

Role: PRINCIPAL_INVESTIGATOR

St. Paul's University, University of British Columbia

Redouane Bouali, MD

Role: PRINCIPAL_INVESTIGATOR

The Ottawa Hospital, University of Ottawa

Sean Keenan, MD

Role: PRINCIPAL_INVESTIGATOR

Royal Columbian Hospital, University of British Columbia

Kevin Eva, PhD

Role: PRINCIPAL_INVESTIGATOR

McMaster University

Brenda Morgan, RN

Role: PRINCIPAL_INVESTIGATOR

London Health Sciences Centre, University of Western Ontario

Lori Hand, RRT

Role: PRINCIPAL_INVESTIGATOR

Hamilton Health Sciences Centre, McMaster University

Locations

Geisinger Health Centre, Temple University

Danville, Pennsylvania, United States

Royal Columbian Hospital, University of British Columbia

New Westminster, British Columbia, Canada

St. Paul Hospital, University of British Columbia

Vancouver, British Columbia, Canada

Vancouver Island Health Research Centre

Victoria, British Columbia, Canada

St. Joseph's Healthcare, McMaster University

Hamilton, Ontario, Canada

Kingston General Hospital, Queen's University

Kingston, Ontario, Canada

The Ottawa Hospital, University of Ottawa

Ottawa, Ontario, Canada

Thunder Bay Regional Health Sciences Centre

Thunder Bay, Ontario, Canada

Sunnybrook Health Sciences Centre, University of Toronto

Toronto, Ontario, Canada

William Osler Health Centre

Toronto, Ontario, Canada

Hotel Dieu Grace Hospital

Windsor, Ontario, Canada

Countries

United States; Canada

References

Sinuff T, Muscedere J, Cook DJ, Dodek PM, Anderson W, Keenan SP, Wood G, Tan R, Haupt MT, Miletin M, Bouali R, Jiang X, Day AG, Overvelde J, Heyland DK; Canadian Critical Care Trials Group. Implementation of clinical practice guidelines for ventilator-associated pneumonia: a multicenter prospective study. Crit Care Med. 2013 Jan;41(1):15-23. doi: 10.1097/CCM.0b013e318265e874.

Reference Type: DERIVED

PMID: 23222254 (View on PubMed)

Other Identifiers

ABATE VAP

Identifier Type: -

Identifier Source: org_study_id