Implementing Evidenced Based Oral Care for Critically Ill Patients
Technical Report,01 May 2009,05 Dec 2014
The Geneva Foundation Tacoma United States
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Purpose This EBP project determined if an evidence-based oral care program resulted in increased nurses knowledge and improved oral care practices compliance. Design The project used a counter balanced design to evaluate the impact of an oral care program, using the Iowa Model. Methods Evidence-based Oral Care EB OC critical care nursing education was conducted over a two-week period using the conceptual underpinning of the Iowa Model, the Diffusion of Innovation process, and project specific oral care evidence-based practice instruction. Knowledge evaluations were conducted at three time points before, immediately after, and 2 months following implementation of the oral care program. Oral care practices were standardized to be conducted every 2 hours and then every 4 hours during 2 six-week sessions. This was followed by a six-week sustainment period and the collection of OC compliance and nurse knowledge data. Two 10-bed trauma surgical critical care units from one Level I trauma military medical center were evaluated.Sample The sample included nurses n 88 and retrospective electronic medical records from 60 patients. Analysis Two-way ANOVA and Kruskal-Wallis non-parametric tests were used to evaluate the impact of the oral care program. Findings Oral care education scores significantly improved over time p 0.0051. The following comparisons of the evidence based oral care compliance were statistically significant baseline compliance when OC was provided every 4 hours p .0001, Q4 best clinical - baseline p .0001, oral care given every 2 hours as compared to every 4 hours p .0001, Q4 best clinical - Q2 p 0.0079, oral care provided every 4 hours during the sustainment period as compared to baseline p 0.0285. Breaking out just oral care components no EBP was significantly higher post compared to pre-test as well p-value 0.0036.