Intensive & critical care nursing : the official journal of the British Association of Critical Care Nurses
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Intensive Crit Care Nurs · Oct 2013
Randomized Controlled Trial Comparative StudyA comparison of Listerine® and sodium bicarbonate oral cleansing solutions on dental plaque colonisation and incidence of ventilator associated pneumonia in mechanically ventilated patients: a randomised control trial.
Effective oral hygiene has been proposed as a key factor in the reduction of dental plaque colonisation and subsequent development of ventilator associated pneumonia (VAP). Listerine(®) oral rinse, while used extensively in dental practice has rarely been tested in mechanically ventilated patients. Sodium bicarbonate as an oral rinse has been more commonly utilised in oral hygiene regimens in intensive care patients. ⋯ Compared to the control group, Listerine(®) or sodium bicarbonate oral rinses were not more effective in the reduction of colonisation of dental plaque or the incidence of VAP. Given the low incidence of VAP, the common factor of a small, soft toothbrush as part of an oral hygiene regimen suggests possible benefit in mechanically ventilated patients.
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Intensive Crit Care Nurs · Oct 2013
The Bedside Oral Exam and the Barrow Oral Care Protocol: translating evidence-based oral care into practice.
To introduce the Bedside Oral Exam (BOE) and the Barrow Oral Care Protocol (BOCP) to guide oral care for intensive care unit patients. Secondary aim: To explore quality improvement data for incidence of ventilator associated pneumonia (VAP), cost effectiveness of oral hygiene supplies and staff response to change in practice. ⋯ A significant reduction in VAP was noted using the BOCP. The BOE guided individualised oral care with contemporary supplies, including a tongue scraper, electric toothbrush, non-foaming toothpaste and oral moisturisers. Cost-effective, comprehensive oral care appears to be effective in reducing VAP. Further studies are needed to assess impact of oral hygiene on oral health and patient comfort.
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Intensive Crit Care Nurs · Oct 2013
Reducing risk for ventilator associated pneumonia through nursing sensitive interventions.
The purpose of this paper is to describe an improvement initiative designed to implement nurse sensitive interventions known to reduce patients' risk for ventilator associated pneumonia (VAP), in cardiothoracic intensive care patients. This initiative is a part of one Australian critical care unit's efforts to identify and measure compliance with key nursing interventions known to improve cardiac surgical patients' outcomes. The premise behind the initiative is that improved nursing process and surveillance systems allow emerging trends to catalyse action and motivate nurses to reduce patients' risk for infection acquisition. At five and nine months following implementation of the initiative a>70% compliance rate in 11 out of the 15 nurse sensitive interventions known to reduce patients' risks for VAP and a drop in VAP incidence from 13.4% to 7.69% from per 1000 ventilator days was accomplished.
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Intensive Crit Care Nurs · Oct 2013
APN-led nursing rounds: an emphasis on evidence-based nursing care.
In today's healthcare environment, nursing staff are challenged to care for patients with increasingly complex needs in an ever-changing environment. Nurses are expected to stay up to date on a tremendous number of institutional initiatives, best practice guidelines, and policies and procedures. These practice imperatives are often disseminated through passive means of information-sharing such as staff meetings and electronic mail. ⋯ The concept of Interventional Patient Hygiene emphasises that basic nursing functions are not only tasks, but also important evidence-based interventions that contribute to improved health for the patient. Interventional Patient Hygiene facilitates the integration of science and practice. This article describes a quality improvement intervention, Advanced practice nurse-led nursing rounds, which supports Interventional Patient Hygiene and be used to help staff integrate best practices while balancing the multiple priorities inherent in nursing care.
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Intensive Crit Care Nurs · Oct 2013
Interventional patient hygiene: discussion of the issues and a proposed model for implementation of the nursing care basics.
More than 140 years ago, Florence Nightingale wrote "It may seem a strange principal to enunciate as the very first requirement in a Hospital that it should do the sick no harm." Data suggests that 63% of all preventable errors are related to clinical problems that are within nursing's independent scope of practice. Many of these fall in the category of "interventional hygiene" activities and include prevention of skin injury, post-operative respiratory complications and failure to rescue. ⋯ The author of this paper, who coined the team "interventional patient hygiene", discusses the science related to many of these care issues and proposes an Interventional Care Model for use by nurses in redesigning how we approach nurse sensitive care practices in the future. Additionally, a change framework called "Sustaining Nursing Clinical Practice" is described to ensure reintroduction and valuing of evidence basic nursing care in conjunction with the right resources and systems to sustain the new practice.