Knowledge, Perceptions, and Attitudes of Critical Care Nurses Towards the Comprehensive Unit-Based Safety Program for Mechanically Ventilated Patients in Preventing Ventilator-Associated Events

Abstract

Background: Mechanical ventilation provides respiratory support for critically ill patients and is one of the most significant life-saving advancements in medical science and technology. Patients on mechanical ventilation are at high risk for complications, such as ventilator-associated pneumonia (VAP), sepsis, Acute Respiratory Distress Syndrome (ARDS), pulmonary embolism, barotrauma, and pulmonary edema (CDC, 2017). The comprehensive unit-based safety program for mechanically ventilated patients, also known as CUSP 4 MVP –VAP, is a collaborative program funded by the Agency for Healthcare Research and Quality (AHRQ) that uses the CUSP principle (AHRQ, 2017). The CUSP principle employs clinical best practices to decrease complications from mechanical ventilation, improve patient safety, clinical outcome, and promote safety culture (AHRQ, 2017). Healthcare organizations who participated in this project reported a significant decrease in VAE rates (AIPSQ, n.d.). Objective: The purpose of this DNP Project is to assess the knowledge of critical care nurses of the evidence based interventions contained in the CUSP 4 MVP-VAP for preventing VAEs and their perceptions and attitudes about safety culture in the work area. The results of this project will allow the project team to understand potential barriers to implementation and provide opportunities to address concerns and needs of critical care nurses who play a significant role in the implementation of CUSP 4 MVP-VAP. Design: This DNP project used a quantitative, descriptive and correlational study to assess knowledge, perceptions, and attitudes of critical care nurses of the comprehensive unit-based safety program, for mechanically ventilated patients or the CUSP 4 MVP-VAP. Setting: The study was conducted at two facilities of Carondelet Health Network: the Carondelet Heart and Vascular Institute (CVHI) on St. Mary’s campus and the medical-surgical ICU at St. Mary’s hospital between October 18 to 25, 2017. Participants: 71 ICU nurses at St. Mary’s hospital in Tucson, AZ. Measurements: A paper survey divided into three parts: demographic characteristics of participants, assessment of knowledge and perceptions and attitudes of nurses towards the new guidelines in the CUSP 4 MVP-VAP. Results: Majority of the ICU nurses are female, held a bachelor’s degree, full-time employee, staff RN in their current position, experienced and expert RN in their clinical competence, and between 40 to 59 years of age. The knowledge scores of ICU nurses were between 10 to 70% with no significant correlation with participant’s demographic characteristics at a-level of 0.05. The ICU nurses has the least knowledge about selective PUD prophylaxis, followed by incorporating early mobility program for intubated patients, recommended frequencies of ventilator circuit changes, tracheal suctioning, and changing the HME. Although 50% of nurses use RASS to keep target sedation level of -1 to +1, only 46% of participants were aware that RASS is not the appropriate tool for assessment of delirium in intubated patients. In addition, only 48% of nurses were aware of the recommended low tidal volume ventilation for ARDS and non-ARDS. The study found no correlation between knowledge of nurses of the CUSP 4 MVP-VAP and perceptions and attitudes of nurses of the evidence-based practice (p-value .474). Conclusion: Based on the study, the cardiovascular ICU and medical ICU at St. Mary’s hospital require substantial need for educational improvement and cultural change. The unit should develop their own CUSP team that will assist in creating a unit-based policies and procedures aligned to current evidence-based practice in preventing ventilator-associated events.