Critical Appraisal of Improvement of Patient Safety for Ventilated Patients
Mechanical ventilation is used to support respiration in patients suffering from debilitating infections or diseases that affect the respiratory system. Its main aim is to promote spontaneous breathing (Hess & Kacmarek, 2014). One of the most common inflammatory conditions which cause debilitating lung disease is pneumonia. The condition causes inflammation in the alveoli, causing them to fill with inflammatory fluid which hinders normal gaseous exchange, and thus ultimately hampering normal respiration. The condition is characterized by cough which is associated with production of phlegm, labored breathing, chest pain, and fever (Nair & Niederman, 2015). Severe symptoms of the condition cause respiratory failure, thus demanding use of mechanical ventilation. Nonetheless, the use of the mechanical ventilator poses the threat of nosocomial infections, especially super-imposed pneumonia which complicates the recovery process.
This nosocomial form of pneumonia is known as Ventilator-associated pneumonia (VAP). VAP is an intractable disease which not only resists treatment but also increases the healthcare costs besides increasing the rate of morbidity and mortality of patients admitted to the Intensive Care Unit (ICU) or High Dependency Unit (HDU) (Hess & Kacmarek, 2014). This is due to the fact that VAP affects critically ill patients whose immune system operates at sub-optimal levels which in turn allows the infection to establish itself in the lungs and develop into a severe condition that worsens the respiratory failure, hence the mortality associated with the condition. It is therefore evident that mechanically-ventilated patients must be safeguarded from contracting VAP during their stay in either the ICU or HDU. The most effective form of ensuring patient protection is through adoption and use of safe clinical practices and processes. This critical appraisal focuses on the clinical practices which improves the safety of mechanically-ventilated patients. This defines the problem statement of the appraisal, and the following study will be appraised in relation to the focus of the critical appraisal.Patient Safety Improvement InitiativeIn a study entitled; Improving Reliability of Clinical Care Practices for Ventilated Patients in the Context of a Patient Safety Improvement Initiative, which was published by the Journal of Evaluation in Clinical Practice, the issue of patient safety in relation to VAP was explored (Pinto et al., 2011).
The problem under study was the factors which influence perception of patient safety improvement as outlined in the guidelines of the Safer Patients Initiative (SPI). These factors were assessed in relation to reliable application of four main clinical care practices which target to minimize VAP. Thus, the clinical problem that was identified was Ventilator-associated pneumonia, and the research problem was how to assess the effectiveness of clinical practices in relation to minimization of VAP infections in the ICU or HDU. If the effectiveness of the safe clinical practices as outlined by the SPI guidelines is qualified and affirmed, then this could improve health care delivery by leading to the standardization of such safe clinical practices as standard operating procedures in ICU and HDU thus improving …