Clinical trial NCT06624540: Impact of Implementing Evidence-based Practice and Nurse's Behavior Change to Improve Quality of Care in Intensive Care Unit in a Tertiary Hospital in Bangladesh
Official title: Impact of Implementing Evidence-based Practice and Nurse's Behavior Change to Improve Quality of Care in Intensive Care Unit in a Tertiary Medical College Hospital (DMCH) in Bangladesh.
Study type: INTERVENTIONAL
Overall status: NOT_YET_RECRUITING
Phase: NA
Conditions: Ventilator Associated Pneumonia (VAP)
Evidence Based Practice
Keywords: evidence based practice
Ventilator Associated Pneumonia
Nurses Knowledge
Lead sponsor: Hiroshima University
Sponsor class: OTHER
First posted: 2024-10-03
Enrollment: 200
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: NA
Intervention model: SINGLE_GROUP
Intervention model description: Study 2: A pre- and post- quasi-experimental study to evaluate the knowledge and skill of nurses.

Study 3: A pre- and post- quasi-experimental study to evaluate the outcomes of the patients in the ICU, using study 1 historical data as a control.
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: Quality of care is crucial for preventing adverse events such as infection in the intensive care units (ICUs). The most common ICU-acquired infections include pneumonia such as ventilator-associated pneumonia (VAP), Central Line Bloodstream Infection (CLABSI), catheter-associated urinary tract in, Medical Device Related Pressure Ulcer (MDRPU) and Pressure Ulcer (PU). This study explores the patient outcome in ICU by examining the causes and prevalence of ICU-acquired infection. The implementation of evidence-based practice (EBP) to reduce infection and change the nurses practice (behavioral changes) to adhere with EBP based on simulation-based training.

General objective:

To evaluate the implementation of EBP by using recent technologies-based equipment to prevent VAP and promote behavior change among nurses for better outcome of the patient in ICU.

Specific Objectives:

1. Evaluate the efficacy of EBP including proper equipment-use for better patient outcomes in the ICU.
2. Evaluate the effectiveness of EBP education by changing nurses' behavior and determine its impact on improving patient outcomes in the ICU.
3. Examine the feasibility of evaluation process and outcomes and successful implementation of EBP in ICU.

Hypothesis:

It is hypothesize that implementing EBP in ICU, including new equipment use and nurses training, will improve patient outcome.

These research consist of three studies:

Study 1: A prospective cohort study design will be applied to estimate the prevalence of adverse events (VAP rate, MDRPU rate, PU rate, CLABSI rate), length of stay and survival rate in ICU. The patients of General ICU will be followed up after admission up to discharge or death at ICU. The investigators use the study findings for our subsequent intervention study 3 as historical data.

Study 2: A pre- and post- quasi-experimental study will be conducted for 6 months to evaluate the nurse's competency on EBP after getting 1-month EBP training. This study has 3 phases: (1) Pre-observation period to measure nurse's competency level for 2-month, (2) nurse's EBP training period with preparation for 1 month, and (3) post-implementation period to measure nurse's competency and implementation of EBP practice for 2 months. Study nurses will receive EBP training, EBP and proper equipment for patient management. The nurses will receive EBP education and training with necessary equipment, such as a close suction catheter, an endotracheal tube, a suction device, and a mouth care brush. In this study, use global standard equipment for the patients safety.

Study 3: A pre- and post- quasi-experimental study will be implemented to evaluate the efficacy of EBP implementation. The investigators use new equipment and implement EBP for patients and assess the patient outcomes. The investigators compare the findings from study 1 (as historical data) with the data from this study 3.

The investigators will compare the VAP infection prevalence and patients' outcomes related to ICU-acquired infection between pre- and post- test phase.


Eligibility criteria: Study 2:

Inclusion criteria:

* Who will be a registered nurse in Bangladesh.
* Who will agree to participate in this study and the EBP training.

Exclusion criteria:

* Who will not directly involve patient care in ICU.

Study 3:

Inclusion Criteria:

* Irrespective of age and sex
* Legal guardian of a patient consents to participation in the study
* Intubated patients after admission.

Exclusion Criteria:

* Who stays less than 2 days at the GICU.
* Who dies or is extubated within 2 days after admitted in the GICU.
* ICU readmission.

Primary outcomes:
measure: The nurse's skill performance is related to VAP checklist
timeFrame: Study 2: 6 months
measure: Incidence rate of ventilator-associated pneumonia (VAP)
timeFrame: 2 months
Secondary outcomes:
measure: A nurse's motivation level will be measured
timeFrame: 6 month
measure: Nurses' sustained implementation measured
timeFrame: 6 months
measure: Organizational readiness measured
timeFrame: 6 months
measure: Nurses knowledge related to VAP prevention measured.
timeFrame: 6 months
measure: VAP episode
timeFrame: 2 months
measure: Interval of VAP occurrence
timeFrame: 2 months
measure: Micro-organism link to VAP
timeFrame: 2 months
measure: Mortality and morbidity rate
timeFrame: 2 months
measure: Onset of VAP
timeFrame: 2 months
measure: Length of stay ICU patients
timeFrame: 2 months
measure: Survival rate in ICU
timeFrame: 2 months
Other outcomes:
Locations:
city: Dhaka
country: Bangladesh
facility: Dhaka Medical College Hospital
city: Hiroshima
country: Japan
facility: Hiroshima University
state: Kasumi 1-2-3 Minami-ku
Study officials:
References: