Study of Knowledge Translation of Clinical Practice Guidelines for Ventilator Associated Pneumonia

Background:

In order to improve the care of our patients, it is necessary for research evidence to be translated into clinical practice. There are gaps in our understanding of knowledge translation (KT) and this is evident in the Intensive Care Unit (ICU), specifically as it applies to the prevention, diagnosis and treatment of ventilator-associated pneumonia (VAP). VAP is associated with a high burden of illness in the critically ill and there is an extensive amount of research evidence on this disease. It has been demonstrated that best practice as defined by research evidence is not uniformly applied to VAP. In addition, recent advances in VAP knowledge need be disseminated and implemented in order to improve patient safety and outcomes from VAP. A systematic process of knowledge transfer is crucial to translate this research into evidence-based bedside practice and the development and implementation of evidence based Clinical Practice Guidelines (CPGs) may facilitate VAP knowledge uptake. In addition, there is a need to study knowledge translation (KT) in the ICU since there is little information about optimal KT and CPG implementation strategies in this environment and efforts that are effective in other clinical areas may not result in meaningful change in the ICU.

Research Question:

What is the effect of VAP CPGs implemented by a multidisciplinary behaviour change strategy (consisting of multifaceted educational strategies led by local opinion leaders and augmented with reminders) on VAP guideline concordance and on clinical VAP outcomes in the ICU?

Research Plan:

Data will only be collected on consecutive patients mechanically ventilated for at least 48 hours. The following health care professionals will be studied to assess the behaviour change strategy for the VAP CPGs: physicians (intensivists, ICU fellows, ICU rotating residents), nurses, respiratory therapists, dieticians, physiotherapists and ICU administrators.

The study will be conducted in 3 phases:

• Development of a behaviour change strategy consisting of three components:

• Local opinion leader team
• Educational strategy
• Reminder system
• Prospective implementation of the behaviour change strategy over a 24 month period
• Prospective evaluation of the behaviour change strategy over a 24 month period

• Concordance with VAP guidelines over time
• Factors associated with VAP guideline concordance
• Clinical VAP outcomes pre- and post-guideline implementation

Inclusion criteria

• Age >= 17 years old
• Mechanically ventilated > 48 hours < 96 hours

Exclusion criteria

• Previous enrollment in the study