Developing an Evaluation Plan

In determining whether an evidence-based change brought out the intended result, evaluation is vital. The outcome of the analysis should point toward the formulation of possible alternative interpretation for the findings (Melnyk & Fineout-Overholt, 2005). The general objective of an evaluation is to determine the effect of the adapted change. To examine the efficacy and probability of the implementation of the protocol, a three-month trial will be done. This is to enhance compliance of respiratory therapists and nurses in executing oral care on patients requiring mechanical ventilation. The evaluation process should answer the following questions:

• Was the oral care protocol initiated properly?
• Did the standardized oral care protocol increased nurses’ compliance with oral care?
• Did the occurrence of ventilator-associated pneumonia decrease after the oral care protocol was implemented?
• Was the oral care implementation recorded according to the new protocol?

For three months, the present study will be implemented in a medical surgical intensive care unit with 20 beds. Patients requiring mechanical ventilation but do not have baseline pneumonia are included in the study. The participants in the process include all respiratory therapists and intensive care unit nurses.

Methods for Evaluation of Effectiveness

• The nurse designated in infection control will document the data regarding the incidences on ventilator-associated pneumonia. A graph illustration of ventilator-associated pneumonia trends within 6 months will be placed on the chart. The graph will show the number of occurrences of ventilator-associated pneumonia each month. The graph will show the occurrence of ventilator-associated pneumonia each month from six months before the implementation of the protocol and after every month.  
• To show correlation, the frequency of oral care and the documented amounts of time of oral care will also be charted from the start of the implementation of the protocol.
• Within an 8-hour time block, a trained research team member will perform a randomized direct observation audit and compare it with pre-implementation data.
• For evaluation use, significant data obtained and discussed during staff meetings will be recorded in abbreviated form.
• For evaluation use, comment suggestion sheets and questionnaires filled out by the nursing staff will also be collected and catalogued.
• All participants involved will be updated on monthly change in VAP rates and monthly level of compliance in oral care.
• The outcome will be evaluated by ventilator-associated pneumonia indicator measurements, such as incidence of VAP, average cost, length of ICU stay, and average ventilator days.
• For compliance degree with oral care, a post-observational audit and implementation chart will be conducted.

Dependent Variables

The quality of oral care and compliance of most nurses and respiratory therapists is not enough to reduce the incidence of ventilator-associated pneumonia in the patient population. This is happening even if they are knowledgeable of the importance of oral care for patients requiring mechanical ventilation. This happens because no consistent oral care guidelines, method, and frequency for performance exist at present.

Independent Variables

The education and experience of the nurses, their knowledge of the hospital’s services and provision of ideal oral care based on the protocol, their attitude towards oral care procedures and the allotted time to perform the proceedings are the independent variables associated with the task. According to Furr et al. (2004), the proposed plan can be greatly affected by the nurses’ attitude towards oral care, their value and importance to the procedure, and their perceived unpleasantness of oral care performances. For example, the actual frequency of oral care determined and the quality of the oral care provided may be limited if observation within 24 hours was not conducted.

Tools for Educating

It is very important to let the staff understand the potential benefit of decreasing the occurrence of ventilator-associated pneumonia and the fundamental reasons supporting proper oral care. To establish the best practices prior to the development of the protocol, a review of literary studies will be conducted. The review will be compiled and presented through handouts and power point presentation to key stakeholders. The protocol will be outlined, and the results obtained from the past chart audits will be put in handouts and made available to all the staff and stakeholders. At different schedules, the administrative groups will be presented with the initial presentation of the protocol by using power point slides. On the other hand, respiratory therapists and intensive care unit nurses will be informed of the new oral care protocol through handouts and power point presentation during weekly meetings. Moreover, posters will be posted in various areas in the intensive care units indicating the fundamental elements of the oral care protocol. Reminder posters will also be posted on the wall at the patient’s head of the bed.

Assessment Tools

For comments, suggestions, and feedback, comment suggestion papers and pre- and post-questionnaires will be distributed to all respiratory therapists and nurses. For the first three months, the education department will hold team meetings to address the oral care limitations, processes change and procedures related to the oral care protocol. The education department will be requested to discuss the importance of proper oral care for patients requiring mechanical ventilation. This will be done during the orientation process of newly-hired employess. Each month, staff meetings will be held to obtain feedback from the staff and share information. Changes will also be made according to the feedback. To see if there are differences after the introduction of the oral care procedures, all respiratory therapists and nurses will be surveyed about the oral care practices. To see if the occurrence of ventilator-associated pneumonia has improved in the hospital from the time when the protocol was implemented, chart audits will be conducted. To implement the protocol, the Plan-Do-Study-Act (PDSA) cycle will be used by planning. The protocol will then be implemented and tested on a small scale at a time. Then it will be analysed and the results will be compared. The protocol then will be adjusted according to the analysed results. When proceedings are not improving accordingly, a champion will be placed to make sure that everything proceeds in the right direction. The identified champion will discuss the problems with the staff and will help keep all involved personnel on the same path.

Dissemination of Evidence

After the completion of the study, the findings will be disseminated to the clinicians and other personnel involved who will use the information in decision-making about patient care. Dissemination mediums should include both written and oral presentations (Melnyk & Fineout-Overholt, 2005). Dissemination will be done for all the nursing community and members of the audience to understand and have access to relevant information regarding the development of the new oral care protocol standard. The key stakeholders will be the first  to inform on the significance of oral care by means of verified and tested studies conducted in other intensive care unit institutions. The information process will be in the form of evidence-based research articles summaries, power points, graphs, and original summaries. Numbers will also be presented about the patients. An example of the use of numbers is the use of percentages for the reduction of ventilator-associated pneumonia after oral care procedures are done, and other hospital-related effects, including the decrease of the patient’s need of care and other cost factors. At first meeting, the same data will be shared with all the nursing staff involved in the oral care implementation. The meeting will also serve to disseminate strategies and information on the oral care changes that are significant to the nursing staff. New information will be derived and disseminated at a monthly meeting with the nursing staff. The information will be presented through power point presentations, handouts, and lectures. Gathering of information will be through questionnaires, suggestion sheets, and vocal reports from nurses. The information will be passed on to the key stakeholders in any form appropriate at their monthly meetings. Barriers anticipated include the lack of time to gather and present data in a filled out form, lack of available time for prioritization, attendance to meetings and completion of questionnaires. The new oral care protocol implementation will be published in the quarterly magazine circulated in the hospitals. The outline of the oral care protocol and the power point presentation will be posted on the the hospital’s website so that the members of the nursing community can assess it. A brief presentation and general overview of the oral care protocol will be discussed in community meetings by the nurse practitioner. The dissemination process and evaluation will be considered successful if it involves careful planning, testing, and modification of the oral care protocol. To increase the oral care compliance of nurses and respiratory therapists, a multidisciplinary approach is necessary. All involved personnel should be committed, and the intensive care administration should encourage them to achieve a successful result.