Application Of Comprehensive Unit-Based Safety Program In The Clinical Practice Transformation Of Ventilator Care Bundles For ICU Nurses

Objective:To understand the knowledge level and clinical implementation status of ventilator care bundles(VCB)for ICU nurses’ in a tertiary Grade A hospital in Shanxi Province,and explore the application effect of the comprehensive unit-based safety program(CUSP)in the transformation of nurses’ VCB clinical practice and safety culture cognition,in order to improve ICU nurses’ VCB compliance and safety culture awareness,promote the transformation of evidence to clinical practice,and provide specific reference for nursing managers.Methods:(1)Current situation survey: Consult relevant domestic and foreign literature,guidelines,and expert consensus to design questionnaires,and use convenience sampling method to select 21 tertiary Grade A hospitals in 10 cities in Shanxi Province from April to May 2022.453 ICU nurses who met the inclusion criteria were surveyed on VCB knowledge and clinical practice to obtain nurses’ self-reported VCB knowledge level and clinical implementation.At the same time,95 nurses were observed on-site in three ICU departments of a hospital by the self-made observation tool and comparing the results of the questionnaire survey report of the same research subjects to objectively and comprehensively understand the current situation of VCB compliance.(2)Intervention study: Using a quasi-experimental pre-post design,this study selected 95 nurses from the Neurosurgery ICU,Respiratory ICU,and Comprehensive ICU departments of a tertiary Grade-A general hospital who met the inclusion criteria.The VCB knowledge questionnaire and adherence observation form were used to collect the knowledge of VCB and clinical adherence rate of ICU nurses before(April-May2022)and after(September-October 2022)the intervention,respectively.The change in ICU nurses’ awareness of patient safety culture was assessed before and two months after the intervention using the Hospital Survey on Patient Safety Culture(HSOPSC)questionnaire.The study evaluated the application effectiveness of CUSP in the clinical practice transformation of ICU nurses’ VCB and patient safety culture awareness.Results:(1)Results of questionnaire survey and on-site observation: A questionnaire survey was conducted among 453 ICU nurses to assess their knowledge of VCB,and the results showed that the correct response rate for questions related to the eight aspects of VCB,including elementary knowledge,bed elevation,monitoring of airbag pressure,and daily awakening and assessment,ranged from 48.34% to 85.43%.The correct response rate for hand hygiene knowledge was the highest.In contrast,the correct response rates for knowledge related to VCB elementary knowledge,suctioning of subglottic secretions,oral care,and daily awakening and assessment were all less than 60%.The results of a clinical execution questionnaire survey among 453 ICU nurses indicated that the compliance rate for hand hygiene was the highest,exceeding 85%,while the compliance rates for bed elevation,cuff pressure monitoring,oral care,management of condensate water,and daily awakening and assessment ranged from 50% to 70%.The compliance rate for suctioning of subglottic secretions was the lowest,at only 25.83%.A comparison of the VCB compliance situation among 95 ICU nurses in a particular hospital using on-site observation and a questionnaire survey showed that the self-reported VCB compliance rate obtained through the questionnaire survey was higher than the on-site observation results to varying degrees,especially for bed elevation(62.11% vs.38.98%)and hand hygiene(82.11% vs.58.12%).However,both methods showed a similar trend in ranking compliance rates for each VCB measure.(2)CUSP clinical intervention results: After the intervention,the correct response rate for questions related to the eight aspects of VCB,including elementary knowledge,bed head elevation were better than those before the intervention.And except for the field of cuff pressure monitoring,the other seven items were statistically different before and after the intervention(P < 0.05);After the intervention,the clinical compliance rate of nurses in the seven parts of VCB such as bed elevation and cuff pressure monitoring increased from 15.81%～78.28% to 51.08%～82.72%;Furthermore,after the intervention,the strength areas(positive response rate > 75%)of nurses’ cognition of patient safety culture increased from 1 to 4,and the weakness areas(positive response rate < 50%)decreased from 2 to 1.The difference of positive response rate before and after intervention was statistically significant(P < 0.05).Conclusion:(1)The evidence-based knowledge and clinical practice of VCB among ICU nurses in a tertiary Grade A comprehensive hospital in Shanxi Province are not ideal,and the gap between evidence-based knowledge and evidence-based practice is obvious.There is still much room for improvement.Furthermore,there are differences between nurses’ self-reported compliance rates and on-site observations’ results,highlighting the importance of comprehensive evaluation.(2)A comprehensive CUSP intervention plan developed based on the current survey results can improve the knowledge level of ICU nurses on VCB,increase the compliance rates of various VCB measures,and promote the transformation of clinical practice.At the same time,it can also improve the nurses’ awareness of patient safety culture and has certain clinical promotion value further to serve the quality improvement projects of the department.