Adherence to Institution-Specific Ventilator-Associated Pneumonia Prevention Guidelines

Abstract

A closed-book, multiple-choice examination following this article tests your under standing of the following objectives:1. Describe the relationship between the increased availability of guidelines for prevention of ventilator-associated pneumonia (VAP) and current adherence to those recommendations. 2. Identify potential barriers to and facilitators of adherence to guidelines for prevention of VAP. 3. Discuss ideas for incorporating study results into strategies for implementation of guidelines for prevention of VAP. Background Various institution-specific guidelines have been developed to prevent ventilator-associated pneumonia. However, the availability of guidelines does not ensure adherence to recommended strategies. Objective To identify factors that influence adherence to guidelines for prevention of ventilator-associated pneumonia, with a focus on oral hygiene, head-of-bed elevation, and spontaneous breathing trials. Methods A cross-sectional descriptive study of critical care nurses at 8 hospitals in Northern California was conducted. A survey was created to gather information on possible facilitators of and barriers to adherence to institution-specific guidelines for preventing ventilator-associated pneumonia. User factors, guideline qualities, and contextual factors were explored and tested for possible relationships. Results A total of 576 critical care nurses participated in the survey. Each hospital had unique guidelines for preventing ventilator-associated pneumonia. In general, nurses had positive attitudes and reported adhering to the guidelines always or most of the time. Factors associated with adherence differed according to the intervention implemented. The score on the user attitude scale was the strongest and most consistent predictor of adherence across interventions (odds ratio, 3.49-4.75). Time availability (odds ratio, 1.54) and the level of prioritization (odds ratio, 1.86) were also significant predictors. ConclusionThe most consistent facilitator of adherence to guidelines for prevention of ventilator-associated pneumonia was nurses' positive attitude toward the guidelines.

Influence of Institutional Guidelines on Oral Hygiene Practices in Intensive Care Units

“…12,16,19 We conducted a multihospital survey study in year 2010-2011 in an effort to understand the factors affecting critical care nurses' VAP prevention practices (oral hygiene, head-of-bed elevated positioning, spontaneous breathing trial, and hand hygiene). 26 We observed great variability in the institutional oral hygiene guidelines and oral hygiene practices. This article is focused on the oral hygiene component of the study to explore how characteristics of institutional oral hygiene guidelines influence nurses' oral hygiene practices and perceptions of that practice.…”

“…Further information on validity and reliability testing is reported elsewhere. 26 Adherence to institutional guidelines was measured by a single item: "I practiced oral hygiene per policy/guideline," and responses were reported on a 4-point Likert scale (1 = never, 2 = sometimes, 3 = most of the time, and 4 = always). The adjective "exactly" was omitted from the original version of the survey ("I practice oral hygiene exactly per policy/guideline," test-retest reliability: r = 0.35) as most procedures must be adjusted slightly to fit the patient's situation.…”

Adherence to the Women's Preventive Services Guidelines in the Affordable Care Act

“…To make contrasts more apparent and consistent with the approach taken by others (Cabana et al, 2001; Kiyoshi-Teo et al, 2014), we also dichotomized the responses to the knowledge, attitudes, and external barrier variables. The single-item factors were considered present if the provider answered 4 or 5 on a 5-point Likert scale, 3 or 4 on a 4-point Likert scale, or 5 or 6 on a 6-point Likert scale.…”

“…Applications include studies focused on adherence to asthma treatment guidelines among pediatricians (Cabana, Rand, Becher, & Rubin, 2001); adherence to preventive cardiology guidelines for women among primary care physicians (Cabana & Kim, 2003); adherence to the National Asthma Education and Prevention guidelines among nurse practitioners (O’Laughlen, Rance, Rovnyak, Hollen, & Cabana, 2013); adherence to ventilator-associated pneumonia prevention guidelines among critical care nurses (Kiyoshi-Teo, Cabana, Froelicher, & Blegen, 2014); and adherence to clinical guidelines on smoking cessation treatment among primary care physicians (Nelson et al, 2015). …”

“…Over the past decade, evidence from these studies and others suggested that provider adherence to clinical practice guidelines is often less than optimal, even when general awareness of the guidelines may be high (Bourgault et al, 2014; Cabana & Kim, 2003; Cabana et al, 1999; Carlson, Glenton, & Pope, 2007; Flores, Lee, Bauchner, & Kastner, 2000; Kiyoshi-Teo et al, 2014; O’Laughlen et al, 2013). Multiple factors may promote or limit providers’ adherence and translation of guidelines into improved patient outcomes, and substantial adherence variation within individual recommendations is embedded in different types of guidelines.…”