The Prevention of Ventilator-Associated Pneumonia in ICU
Executive Summary
Intensive care unit has been offered to patients who are at the stake of extreme health issues. In the present report, the issues and problems regarding ventilator-associated Pneumonia were identified to analyze the relevance of VAP in medical science and health care management. Understanding the problems had enabled them to analyze the real-world scenario, and Nuffield Health had been selected. Specifically, the Bristol hospital of Nuffield Health had been analyzed with the SWOT strategy. The analysis had identified the different issues and problems regarding the situation, and based on the SWOT analysis, the plan of improvement and the recommendation has been proposed.
Table of Contents
Background of the Organization 4
Analysis of the Chosen Process 6
Introduction
Ventilator-associated Pneumonia is a disorder related to lung infection. Patients who are kept under the assistance of the mechanical breathing system majorly face issues regarding Ventilator-Associated Pneumonia (VAP). In the ventilation process, Oxygen has been injected by placing a tube in the mouth, nose and even sometimes making a hole in front of the neck. The occurrence of germs through the tubs is the reason for infection in these areas. Hence, the consideration of a plan to recover the issues regarding the infection at these places has been required. Even the infection can be entered into the patient’s lung and cause severe issues, even life risk. For this reason, the surveillance of the patients at the Intensive care unit (ICU). In Nuffield health, the health care, the Bristol Hospital, has been selected for the present analysis. Where Ventilation services have been provided to the patients with severe health issues. Where. The ventilation process has been designed to offer digital technology, and the digital technology-enabled Quarters have been designed for the in-tubing process.
Problem statement
Boltey et al. (2017) opined that Nosocomial infection had been termed as one of the critical reasons for the death of the patients at the intensive care unit. Patients at the Intensive care Unit have a risk of morbidity due to the complexities of the illness. Still, several risks of dying have also been associated with the secondary processes, among which the nosocomial issues and the nosocomial disorder is the prominent reason (Boltey et al., 2017). Pneumonia has the second most probability of occurrence in critical nosocomial infections with a 27% rate to affect the health of the students. These nosocomial infections and Pneumonia have a rate of 86% association with the mechanical ventilation process and the VAP. An NCBI report of 2017 has proposed that the VAP rate has been varied between 5% to 67% (Filiberto and Croce, 2018). The change in the rate has been varied depending on the case mix and the diagnostics. Among the elderly people, the rate of VAP is much higher and has been caused in the immune-compromised patients who experienced the surgical operations. Based on the above-mentioned facts and statistics, the issues of VAP have been observed as an important issue of the nosocomial infection and leads to the death of the patients under the Intensive care unit. In terms of the secondary risks related to the death of the patients at the ventilation Centre, VAP is the second most prominent issue.
Common Facts
The concept of VAP has been considered as a benchmark for the overall quality management of the healthcare system. The VAP can be minimized with effective steps and measures in the health care treatments (Cdc.gov. 2021). Qualitative distal processes for the bacterial presence examinations have been considered an important aspect to confirm the suspicion regarding the VAP. in healthcare organizations; during the ventilation, the bacterial specifications have been tested regularly to check the infection (Guillamet and Kollef, 2015.). Using appropriate Antimicrobials can be effective for the treatment of VAP. Avoiding the unnecessary usage of the broad-spectrum antimicrobials, the treatment of the VAP can be performed under the quality of Care.
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Background of the Organization
Nuffield Health is one of the prominent health charity organizations that was established in the year 1957 and under which the 31 Hospitals have been kept operating. The Bristol hospital is one of the significant units of this health care chain. This organization has kept its operation sustained, staying independent from the NHS (Nuffield Health,2021). It is a registered charity of the UK with an operational approach to promoting health care and the UK’s well-being. The organization has an approach of constant development and improvement of their services to offer a stable and sustainable health care facility. As a part of the innovative approach, Nuffield services have considered acquiring the services of cognitive-behavioural health and considered psychological development as a part of the improved health and well-being of an individual. Nuffield Health has a diverse treatment facility that has covered the different servicer units and facility centres. Bristol Hospital is the Pioneering institute of Britain in terms of providing quality services and cares to the patients (Nuffieldhealth.com. 2021b). As a part of the innovative approach of the Nuffield, Bristol hospital has been awarded the best health investor award. The organization has an option to offer treatment with the capacity of 30 beds along with the digital theatres for the improved quality of the health care services. As a part of the quality services, leading-edge clinical facilities have been applied in the organization, ensuring an outstanding customer experience. Experts from the UK have partnered with the organization to manage health care services. Enabling the digital services, the hospital offers the facility to contact the 102 medical experts to take treatment. The organizational approach to build a full-fledged organizational structure for Intensive care treatment and surgery management to promote the health stability and the well-being of the greater humanity. As a part of the organizational approach to develop a strong structure to promote the safety of human health, the consideration of the VAP issues and the methods of solution to maintain the health hygiene and safety of the patients at the health care unit. (Nhs.gov.uk, 2021). The plan for improvement will enable a transparent critical care unit at the organization for the treatment of the surgery and the critical patients with minimizing the risk of VAP in the organization, enabling the digital technology.
Problem Analysis
VAP has been related to the infection caused by mechanical ventilation. Immediately after the Intubation, approximately after 48 hours, the infection has erupted. Guillamet and Kollef. (2015) identified that When the Endotracheal tube has been inserted, the colonization of the viruses can occur at the Respiratory tract. This colonization of the virus and the incoming pathogens has impacted the flow of the Cheobroncheal mucus flow and impacted flow caused the retained secretions and resulted in Pneumonia. In mechanical ventilation, the process of VAP has been prolonged for 11 days and resulted in an increase in staying at the hospitals (Sherlaw-Johnson et al., 2018). The major problems that have been identified in the organizations and the treatment at ICU regarding the VAP has diverse form. Some of the issues regarding the VAP can not be altered as those are inherent. The issues faced or the problems identified regarding the VAP in the organizations have been mentioned below-
The issue regarding the VAP is that the rate of clinical diagnosis is highly inaccurate as the percentage of accuracy has been limited to 50%. Along with it, the microbiological cultures can not be enough for the diagnosis of the VPA. VPA has similarities with the tracheobronchitis related to the ventilator (VAT) (Timsitet al., 2017). VAP has also been treated as a nosocomial infection. The risk of fall and the morbidity from the VPA disease is highly related to the non-modifiable risk factors of VAP and the non-modifiable trauma related to it. Hence, the consideration of the quality healthcare services and the quality of the health care (Sherlaw-Johnson et al., 2018). In the particular organizational context, the consideration of the risk patients with extreme importance has been defined as the key element. Poor health care treatment related to ventilation management at the Integrated care unit has created these issues. The improved intubation process and the management of the ventilation can enhance the process’s effectiveness and minimize the risk of occurrence of VAP-related problems in the organizations (Filiberto and Croce, 2018).
Opportunity Analysis
The issues and problems that have been identified in the organizational operation are subjected to the quality improvement of the ventilation. The minimization of the exposure area of the ventilator has minimized the exposure of patients to the mechanical system of the ventilator. This less exposure to mechanical systems has also minimized the exposure to the virus, microbes, and the risk of the VAP Can be minimized. Mechanically ventilated patients have higher exposure to their oral health. Wenger al. (2017) have mentioned that the Oral Mucosa of the patients has been injured during the Intubation. As a result, dry mouth issues can be observed after the Intubation, and the indirect impact of the dry mount is the infection in the mouth. Hence, higher oral hygiene has minimized Bacteria colonization and minimized the risk of infection at the Endotracheal tubes (Kallet, 2015). Subglottic suctioning can minimize the accumulated secretions near the endotracheal tube. Proper positioning of the tube, making an angle of 30-45 degree angle between the bend and head, has minimized the risk of the VAP, and early mobilization of the patients has minimized the source of infection. Reflux and the risk of VAP related to the reflux can also be minimized by making the 30-45 degrees elevated to the head of the bed (Sherlaw-Johnson et al., 2018). These are some of the operational management opportunities that can be used for the minimization of the risk of occurrence of the disease (Wenget al., 2017). The minimization of the risk and morbidity rate can be minimized with an approach of adequate staffing for the patient’s Care. The adequate nurses at the service of the patients can minimize the risk of falls of the patients, and the health variables of the patients can be tracked regularly that minimizes the risk of VAP.
Strategic Context
Bristol hospital has been employed in the service of humanity for the last 50 years with an objective to offer competitive health care services. Nuffield health and the Bristol Hospital areas to work for the public benefit to promote, improve, and activate quality healthcare with minimum issues in the service design. The utmost importance of the organization is to deliver a superior customer service experience at the hosp[ital through the medical service facility (Filiberto and Croce, 2018). As a part of the organizational approach regarding the quality improvement of the ICU and the ventilation service, the company has taken an approach to digitizing the process within the automation technology for more accurate precision in the service setting. The organization’s focus is on public health, and the organization’s approach to addressing the public issues has been considered to improve the health and well-being across the spectrum and the prevention of the activities through Care (Kallet, 2015). The organizational approach has a wide context of relevance to the present issues and the approach of improvement (Munro and Baker, 2018). The organization has an approach to digitize the performance and adopted digital technology, which improves the intubation process, and the alignment of the patients on the bed can be fixed with it. Along with it, the position of the patient on the bed can also be identified with perfect precision. Whence, the improvement plan has been required to improve the ICU facility of the organization. The approach of the organization is to check the health and well-being of an individual through close intervention. As a part of their intervention strategy, it has been observed that the firm has faced an increment in this activity with a 27% hike in the year 2017, compared to the situation of 2016 (Munro and Baker, 2018). Hence, the understanding of the intervention process regarding the development of the ICU and the risk of VAP can be minimized.
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Analysis of the Chosen Process
SWOT Factors
| Strength | Weakness |
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| Opportunities | Threats |
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SWOT Analysis
The organization has shown some excellent performance in managing the health and well-being of an individual regarding their health care development. But the ventilation process of the organization has been developed to be strong with the organizational approach to implement cutting-edge technology in every sector of the surgery and the intensive care units. The organization has formed all the well-equipped platforms for the treatments as the candidates and patients can get assured service at the organization (Roue, 2021). Along with it, the organization has also installed the different service facility units at the organization. The en-suite process and the Sioux bed recovery system have enabled smoothness in the service facility. To enable strong supervision of the patients in the organization. The presence of the nurses to attend to the patient has also been ensured in the organization (Nuffieldhealth.com. 2021a). As an overall effect to develop a strong organizational structure for quality improvement, the four structures have been designed as a part of the intensive service offering for the organization. The organization has also encountered the progressive management of the healthcare facilities and the ICU management with visionary leadership. Along with it, the strength of the organization in the brand value of Nuffield health. The healthcare organization has been transformed to a strong brand for their effective performance till the date, starting from 60 years ago (Nuffield Health,2021). Though the cutting-edge technology has been implemented, the organization had to achieve the automation technology in the service quality management of the organization for the strong intervention of the surgery and ventilation process.
5S Model
| 5S Phase | Definition | Standards To Be Met | Ratings | ||||
| Date | 17.01.2021 | 18.02.2021 | 18.03.2021 | 18.04.2021 | 10.05.2021 | ||
| Sort | Availability of the right elements | Adequate Nursing staff for the organization | 1 | 3 | 2 | 3 | 3 |
| The leadership of the organization to maintain the balance of the workplace of treatment | 2 | 2 | 3 | 3 | 3 | ||
| Set in Order | Orderly management of the resources | Structure of the critical care units of the organization. | 3 | 3 | 2 | 3 | 3 |
| The intervention of the health status under the intervention of the expert medical officers. | 2 | 3 | 3 | 1 | 2 | ||
| Shine | Every element of the organizations | Cleaning and germ treatment of the areas after every treatment of the patients. | 1 | 3 | 2 | 1 | 3 |
| Implementation of the cutting-Edge technology. | 3 | 1 | 2 | 3 | 2 | ||
| Standardize | The standard procedure of the health treatment and the ventilation management | Strongly compliance with the NHS Guidelines. | 1 | 2 | 3 | 2 | 3 |
| Performance Audit of the service facilities. | 2 | 3 | 1 | 2 | 3 | ||
| Sustain | Investment in innovation for the improvement of the service quality and improvement of ventilation. | Investment in the digital technology innovation | 3 | 3 | 2 | 1 | 1 |
| A strong brand image with 60 years of operational history forms a bond of trust. | 3 | 2 | 3 | 1 | 3 | ||
| Total value | 21 | 25 | 23 | 20 | 26 | ||
Improvement Plan
5S Phase of the improvement plan has been considered for the analysis of the improvement and suggested below-
| 5S Phase | Definition | Requirement |
| Sort | Sorting of the process of the ventilation and Intubation to improve the quality of the ventilation management. To mitigate the challenge of e VAP of a patient in the Service facility. Sorting of the different processes to meet the requirement for the improvement of the VPA in the ICU sections. | Minimization of the ventilation Exposure by minimizing the patient’s exposure to the mechanical process of the ventilation (Cornisteinet al., 2018). |
| Encouragement for the usage of the Noninvasive ventilation process | ||
| Implementation of the Bilevel positive Airway pressure. | ||
| Evidence-based care Bundles for the improvement of the patients’ exposure to the mechanical system. The strong Supervision of the Nurses and The Medical experts (Klompaset al., 2014). | ||
| Set in Order | After the selection of the primary needs and the demands for the improvement, the selection of the objects to put them in order is required for the improvement of performance. | Identification of the ventilator weaning process and the Intubation procedure. |
| Engagement of the capable staff to handle the need and demands of the Patients. | ||
| Regular treatment and the supervision of the health status of the patients after the admission to the hospital (Cornisteinet al., 2018). Regular performance of the microBiome test for the analysis of the situation. | ||
| Repetition of the test for the VAP suspects as the test result has less than 50% Accuracy. Along with it, the implementation of digital technology for improved service quality and the service facility for the Patients. | ||
| Shine | When the order method of the improvement has been defined, the next step for the improvement is to consider how fair and well organized the performance is (Nhs.UK. 2021). In the present section, the steps and initiatives that the organization can take have been mentioned. | Minimization of the ventilator Exposure and the maintenance of the hygiene of the patient and the ICU area with extreme importance. The clean and Hazard free environment in ICU |
| Intubation in the ventilation for the med at the natural areas and facial areas of the body. Hence, Excellent oral health maintenance has been required. | ||
| Subglottic Suctioning has been improved for the improvement of the VAP., as the subglottic suctioning has minimized the risk of the VAP by 45%. | ||
| Ensure mobility of the patients during the ventilation to ensure enough air in the areas of the Intubating to avoid contamination at that area. | ||
| Standardize | The performance of the healthcare facility and the service quality can be improved with the standardization of the performance through the management of the workplace. The risk reduction and the enhancement of the opportunity can be ensured with the standardization of the performance. | For standardized p[erformance, enough staffing for the intervention of the health standard of the patient has been required. |
| The position management of the patient at the ventilation care unit has improved the health performance of the individual. The gastric reflux can be controlled by Positioning the patient 30-45 degrees (Klompaset al., 2014). | ||
| Inclusion of the subglottic suctioning Is the efficient standard for operation as a part of Coordinated Care. The Risk of Suctioning can be reduced by 45%. Hence, it has been selected to include in the standard of operation (Koenig and Truwit, 2006). | ||
| The collaborative approach of the nurses along with the family members of the patient and the medical officer for the sustainable and stable treatment of the patients, minimizing the risk of the VAP (Nhs.UK. 2021). | ||
| Sustain | Incorporation of the four standards in practice, for the sustainability of operation, it has been required to follow some of the specific criteria and guidelines regarding the management of health status and sustainability of the p[ateints under VPA and minimization of the risk of VPA. The organizational approach with the medical facility development and the services quality improvement as well as the evidence-based Care can be offered with the employee improvement at the health care. | Evidence-based practice of the health workers should regularly follow the symptoms of the patients and the other health variables (Nhs.UK. 2021). Regular pulse checking and mobility of the patient have been required. |
| Information management within the organization has been required for the knowledge transfer within the organization (Koenig and Truwit, 2006) so that the employees of the organization can improve their performance. | ||
| Training regarding the performance improvement of the employees. The improvement of the employee’s performance in service offering (Koenig and Truwit, 2006). The organization can also focus on the leadership improvement approach to ensure strict adherence to the regulation by the nurses and other employees of the organization. | ||
| Training regarding the updated method of Intubation and the process of intervention need to be trained to the employees for better performance (Nhs.UK. 2021). |
Recommendation
After the analysis of the whole problem, the recommendations provided for the improvement of the VAP services could be laid under the following points:
- As it has been observed that the accuracy level of the diagnosis is 50% improvement in the clinical diagnosis procedures of VAP with higher accuracy level by imparting upgraded knowledge and practical support to the staff and nurses would be helpful to uplift the accuracy level of diagnosis.
- Improvement of healthcare units with conventional training and development of ventilation systems why the implementation and application of upgraded technologies would be helpful for a better outcome.
- Along with the microbiological culture, the staff and the nurses would be trained with proper training to provide better treatment to the infected person pragmatically.
- Application of the Braille translation service would be helpful for the treatment of deficiency in the service centre.
- Strategic early design service sector for providing accommodation to the families of the infected person during the treatment would help provide mental support to the family as well as the patient.
- Updating the whole ICU with computerized and digital theatres would be helpful for the treatment of the patient and monitoring of the health at the same time.
- Providing proper information of the service and the treatment that would be then in the ventilation to the staff nurses and the family members would help execute the whole function smoothly.
- Improvising the machinery with the implementation of innovations and technology in the ICU sector would be helpful for the up-gradation of the treatment.
- Improvement in the services of children’s health and surgery by providing a different section and training nurses for looking after children’s health would be helpful.
- Along with the patients, the staff and the workers of the healthcare sector are also important. Henceforth, providing better development to the staff and the assistance would help in acquiring the dedication from them, resulting in the up-gradation of service providence.
- The outbreak of the pandemic situation has deteriorated the services in the ICU sections, and recommendations to upgrade the operations by employing more nurses and staff would be helpful for the healthcare sector.
Conclusion
The study successfully stated about Ventilator-associated pneumonia (VAP), a disorder related to lung infection. It discusses the problem statement and the issues faced by the healthcare sector due to this disorder. The report also brings into limelight the common facts of VAP. The study focuses on the Nuffield health organization and the issues faced by the organization. As the health organization was a registered charity of the UK with the operational approach to promoting the healthcare and the well-being of the citizens of the place, there were certain challenges that the foundation has been facing to improve its activities by providing the best support to the patients. The evaluation of the problem analysis has been elaborately described with the opportunity analysis and the strategic context. The chosen process that has been implemented in the healthcare organization has faced challenges and issues that could be minimized by recognizing the strengths, weaknesses, opportunities, and the presentation of the swot analysis successfully shows the performance in managing the health and well-being of an individual regarding the health care development. Analysis of the recommendation would help to understand the way by which the whole process would be upgraded and improved for the betterment of the healthcare sector. Henceforth, it could be concluded that the implementation of the improvement plan and the up-gradation of training facilities to the nurses and the staff would, in turn, change the whole scenario pragmatically.
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