Effect of Implementing Evidence-based Practice and Nurse's Behavior Change on Quality of Care in Intensive Care Unit: Focus on Ventilator Associated Pneumonia in a Tertiary Hospital in Bangladesh

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

272 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-10-10

Study Completion Date

2026-02-28

Brief Summary

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Quality of care is crucial for preventing adverse events such as infection in the intensive care units (ICUs). The most common ICU-acquired infections include pneumonia such as ventilator-associated pneumonia (VAP), Central Line Bloodstream Infection (CLABSI), catheter-associated urinary tract in, Medical Device Related Pressure Ulcer (MDRPU) and Pressure Ulcer (PU). This study explores the patient outcome in ICU by examining the causes and prevalence of ICU-acquired infection. The implementation of evidence-based practice (EBP) to reduce infection and change the nurses practice (behavioral changes) to adhere with EBP based on simulation-based training.

General objective:

To evaluate the effect of EBP by using recent technologies-based equipment to prevent VAP and promote behavior change among nurses for better outcome of the patient in ICU.

Specific Objectives:

1. To determine the incidence of adverse events (VAP rate, MDRPU rate, PU rate, CLABSI rate), length of stay and survival rate in ICU.
2. To evaluate the effectiveness of EBP education by changing nurses' behavior and determine its impact on improving patient outcomes in the ICU.
3. To evaluate the effectiveness of EBP including proper equipment use and changed nurses behavior acquired through the training for better patient outcome (VAP ratio) in the ICU.
4. To examine the feasibility of evaluation process and outcomes and successful implementation of EBP in ICU.

Hypothesis:

It is hypothesize that implementing EBP in ICU, including new equipment use and nurses training, will improve patient outcome.

These research consist of three studies:

Phase 1: Incidence of adverse events (VAP rate, MDRPU rate, PU rate, CLABSI rate), length of stay and survival rate in ICU. The patients of General ICU will be followed up after admission up to discharge or death at ICU. The investigators use the study findings for our subsequent intervention study 3 as historical data.

Phase 2: A pre- and post- quasi-experimental study will be conducted for 6 months to evaluate the nurse's competency on EBP after getting 1-month EBP training. This study has 3 steps: (1) Pre-observation period to measure nurse's competency level for 2-month, (2) nurse's EBP training period with preparation for 1 month, and (3) post-implementation period to measure nurse's competency and implementation of EBP practice for 2 months. Study nurses will receive EBP training, EBP and proper equipment for patient management. The nurses will receive EBP education and training with necessary equipment, such as a close suction catheter, an endotracheal tube, a suction device, and a mouth care brush. In this study, use global standard equipment for the patients safety.

Phase 3: A pre- and post- quasi-experimental study will be implemented to evaluate the efficacy of EBP implementation. The investigators use new equipment and implement EBP for patients and assess the patient outcomes. The investigators compare the findings from study 1 (as historical data) with the data from this study 3.

The investigators will compare the VAP infection prevalence and patients' outcomes related to ICU-acquired infection between pre- and post- test phase.

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Detailed Description

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Conditions

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Ventilator Associated Pneumonia (VAP) Evidence Based Practice

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Phase 1: Incidence of adverse events in ICU(VAP rate, MDRPU rate, PU rate, CLABSI rate) length of stay, survival rate.

Phase 2: A pre- and post- quasi-experimental study to evaluate the knowledge and skill of nurses.

Phase 3: A pre- and post- quasi-experimental study to evaluate the outcomes of the patients in the ICU, using study 1 historical data as a control.

Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

NONE

Study Groups

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Experimental: Phase 2: All Nurses in GICU; Phase 3: All patients admitted in the general GICU

Nurses: All nurses who work at GICU of DMCH Patients: all patients who will admit at the assigned GICU during the study period of DMCH

Group Type EXPERIMENTAL

This is a pre- and post- quasi-experimental study.

Intervention Type BEHAVIORAL

We will use new equipment and implement EBP (VAP management) for patients by trained nurses (Phase 2) and check the outcome of the patients. We will compare our phase 1 findings for this study as historical data.

Education with EBP

Intervention Type BEHAVIORAL

Phase 2: Nurse's EBP training ( VAP management), 2 hours lecture and 3 hours skill training for total 4 times in 1 month.

Phase 3: Introduce new equipment necessary for EBP implementation for VAP management, and EBP-trained nurses implementation for VAP management.

Interventions

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This is a pre- and post- quasi-experimental study.

We will use new equipment and implement EBP (VAP management) for patients by trained nurses (Phase 2) and check the outcome of the patients. We will compare our phase 1 findings for this study as historical data.

Intervention Type BEHAVIORAL

Education with EBP

Phase 2: Nurse's EBP training ( VAP management), 2 hours lecture and 3 hours skill training for total 4 times in 1 month.

Phase 3: Introduce new equipment necessary for EBP implementation for VAP management, and EBP-trained nurses implementation for VAP management.

Intervention Type BEHAVIORAL

Other Intervention Names

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Phase 2: Nurses EBP training

Eligibility Criteria

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Inclusion Criteria

* Who will be a registered nurse in Bangladesh.
* Who will agree to participate in this study and the EBP training.

* Irrespective of age and sex, participant must be 18 years old.
* Legal guardian of a patient consents to participation in the study
* Intubated patients after admission.

Exclusion Criteria

* Who will not directly involve patient care in ICU.

Study 3:

* Who stays less than 2 days at the GICU.
* Who dies or is extubated within 2 days after admitted in the GICU.
* ICU readmission.

Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes