Based On FOCUS-PDCA Nursing Program In The Management Of Ventilator-associated Pneumonia Applied Research

Objective:1.To analyze the related factors affecting the occurrence of ventilator associated pneumonia(VAP).2.To compare and analyze the compliance of medical staff to different bundle management strategies and the difference in of their impact on the occurrence of VAP.3.To explore the effect of the bundle management strategy based on the FOCUS-PDCA procedure on the compliance of medical staff,the incidence of VAP and the duration of mechanical ventilation in patients.Method:Using the 9 steps of the FOCUS-PDCA procedure find(F),organize(O),clarify(C),understand(U),select(S),plan(P),do(D),check(C),and act(A)and dividing them into two parts to carry out the following research:The first part:Taking the intensive care department of a tertiary hospital in a city as the observation point,it is clear that the high incidence of VAP is a current problem(find,F),and a continuous quality improvement(CQI)group(organize,O)is established.Through literature review and brainstorming,the potential factors affecting the occurrence of VAP were identified,and a general medical record questionnaire was made to carry out a retrospective case-control study on the mechanical ventilation patients admitted to the department in 2020.VAP Bundle Management Strategy Record Form for Prevention and Control was used to screen potential influencing factors,and SPSS26.0 was used to conduct univariate analysis and logistic regression analysis to clarify the risk factors affecting the occurrence of VAP(clarify,C).Find the modifiable part of the factors that affect the occurrence of VAP.The second part:A survey of clinical baseline data was conducted among mechanically ventilated patients admitted in this department from January to June 2021,and the updated "VAP Bundle Management Strategy Record Form for Prevention and Control" was used to check the compliance of clinical medical staff with various measures(understand,U).Univariate regression analysis was performed on the compliance verification data using SPSS26.0,and the compliance of medical staff to different bundle management strategies and their influence on the occurrence of VAP were compared and analyzed.Select the item that needs to be strengthened(select,S).Rank the items that need to be strengthened according to the size of the correlation.After discussion,the group members determine the final optimized VAP bundle management plan(plan,P)and plan to implement it.The optimized VAP bundled management strategy will be clinically implemented in the Department of Critical Care Medicine from September to November 2021(do,D),and the nurses and researchers will check and record the compliance of the bundled management strategy and the occurrence of VAP and the duration of mechanical ventilation(check,C).Using SPSS26.0 univariate test,the compliance of cluster management strategy,the incidence of VAP and the duration of mechanical ventilation of patients were compared and analyzed with the situation of the department from September to November 2020,and the effect of optimized measures was discussed.Rectify weak links in the next cycle(act,A).Result:1.The results of medical record data collection showed that:state of consciousness,smoking history,initial APACHE Ⅱ score,mechanical ventilation time,and compliance with bundled management strategies were the influencing factors to the occurrence of VAP,and the differences were statistically significant(P<0.05).2.The compliance results of medical staff in implementing 9 bundled management measures show that only 4 measures have an implementation rate higher than 95%,namely oral care,daily wake-up,daily assessment of whether to wean off or extubate,and respiration.While the implementation rate of disinfect and replace the machine and accessories in time;check whether to stop or reduce the amounts of sedative drugs,raise the head of the bed by 30-45° without contraindications,continuously monitor the pressure of the air bag,clean the condensed water in the ventilator pipeline in time,and strictly implement hand hygiene is all below 95%.The incidence of VAP in the compliance group was significantly lower than that in the incomplete compliance group among the 7 measures,and the difference was statistically significant(P<0.05).oral care,timely cleaning of condensed water in the ventilator pipeline,daily wake-up,continuous monitoring of airbag pressure,daily evaluation of whether to wean or extubate;There was no significant difference in the following two measures of the two groups:checking whether to stop or reduce the amounts of sedative drugs,ventilator and accessories timely disinfection and replacement(P>0.05).3.The overall compliance of medical staff to the optimized VAP bundle management measures increased to 64.8%compared with before optimization(27.7%),and the difference was statistically significant(P<0.05).After adopting the optimized VAP bundle management strategy 5 patients in the group developed VAP,and the incidence of VAP was reduced to 9.3%compared with the historical control group(13.3%).After the optimization of the VAP bundle management strategy was adopted,the mechanical ventilation time of the optimized group was significantly shortened compared with that of the control group in the same period of history difference was statistically significant(P<0.05).Conclusion:1.The compliance of medical staff to the bundled intervention strategy is the influencing factor of VAP,and it is controllable.2.The current situation of medical staffs compliance with the cluster management strategy has not reached the ideal state,and the medical staff’s compliance with different cluster management strategies has different effects on the occurrence of VAP.3.Based on the FOCUS-PDCA procedure to optimize the VAP cluster management strategy,it can improve the compliance of medical staff to the optimized cluster management strategy,shorten the mechanical ventilation time of patients,and is expected to reduce the incidence of VAP.