In January 2021, the COVID-19 multidisciplinary clinical team at our hospital noted a sharp rise in the number of COVID-19 patients developing ventilator-associated pneumonia 48-72 hours after admission. The nurse leader and nurse informaticist (NI) to applied clinical reasoning and judgment to make the choice of extracting data from the hospital’s electronic health records (EHR) for knowledge dissemination, generation, and processing (Nelson, 2018). The nurse manager and NI extracted data for all the patients hospitalized on 10th January 2021, for severe acute respiratory syndrome (SARS) requiring artificial ventilation NURS 5051/ NURS 6051 week 1 Discussion: The Application of Data to Problem-Solving.
An analysis showed that a total of 11 COVID-19 patients were mechanically ventilated after their states deteriorated following severe respiratory failure. Seven of the 11 patients were male and four female, with a mean age of 61 years. Approximately 73% of the 11 patients developed VAP within 48 – 96 hours after ICU admission, resulting in a loss of 45.45% to VAP-related inpatient deaths. Six of the patients representing 54.54% recovered and were discharged from the ICU from 13th – 20th January 2021. Further analysis of the data revealed that age was a possible predictor for acquiring VAP, with all patients aged developing VAP and none of the three patients aged ≤ 45 years developed VAP. Besides, all the patients who died from VAP complications were aged above 70 years, and the younger patients with no VAP cases spent at most 96 hours in the hospital. In line with findings in published literature, the multidisciplinary team confirmed that VAP not only increases the odds for inpatient mortality but also prolonged the length of ICU and hospital stay for at least 9 – 13 days (Maes et al., 2021; Ippolito et al., 2021).
The multidisciplinary team evaluated data-based quality improvement guidelines recommended by the IHI and AHRQ, as well as empirically tested interventions aimed at reducing the risk of VAP among mechanically-ventilated patients. The evaluation led to the recognition that, while the team implemented the IHI Ventilator Bundle, compliance with the bundle was substantially low, with a large share of the patients’ health records lacking documented daily goals sheets (IHI, n.d.). The hospital’s COVID-19 multidisciplinary team developed a digital signature (electronic search algorithms) to track the team’s adherence with the components of the Ventilator Bundle and assess the effectiveness of specific components in mitigating VAP (IHI, n.d.). The virtual signatures were incorporated with the patients’ medical records, such that in case one is not completed, the ICU nurse would be notified to complete all the four Ventilator Bundle components. Thus, nursing informatics facilitated not only the identification of the clinical problem but also the formulation of evidence-based solutions to VAP among COVID-19 patients.
Institute of Health Iimprovement. (n.d.). Ventilator-associated pneumonia. http://www.ihi.org/Topics/VAP/Pages/default.aspx
Ippolito, M., Misseri, G., Catalisano, G., Marino, C., Ingoglia, G., Alessi, M., Consiglio, E., Gregoretti, C., Giarratano, A., & Cortegiani, A. (2021). Ventilator-associated pneumonia in patients with covid-19: A systematic review and meta-analysis. Antibiotics, 10(5), 1–19. https://doi.org/10.3390/antibiotics10050545
Maes, M., Higginson, E., Pereira-Dias, J., Curran, M. D., Parmar, S., Khokhar, F., Cuchet-Lourenço, D., Lux, J., Sharma-Hajela, S., Ravenhill, B., Hamed, I., Heales, L., Mahroof, R., Solderholm, A., Forrest, S., Sridhar, S., Brown, N. M., Baker, S., Navapurkar, V., … Conway Morris, A. (2021). Ventilator-associated pneumonia in critically ill patients with COVID-19. Critical Care, 25(1), 1–11. https://doi.org/10.1186/s13054-021-03460-5
Nelson, R. (2018). Informatics: Evolution of the Nelson data, information, knowledge and wisdom model: part 1. OJIN: The Online Journal of Issues in Nursing, 23(3). https://doi.org/10.3912/OJIN.VOL23NO03INFOCOL01