Early Mobilization in the ICU for Mechanically Ventilated Critically Ill Patients.

In this assignment, you will propose a quality improvement initiative from your place of employment that could easily be implemented if approved. Assume you are presenting this program to the board for approval of funding. Write an executive summary (750-1,000 words) to present to the board, from which the board will make its decision to fund your program or project. Include the following:Early Mobilization in the ICU for Mechanically Ventilated Critically Ill Patients.

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The purpose of the quality improvement initiative.
The target population or audience.
The benefits of the quality improvement initiative.
The interprofessional collaboration that would be required to implement the quality improvement initiative.
The cost or budget justification.
The basis upon which the quality improvement initiative will be evaluated.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.Early Mobilization in the ICU for Mechanically Ventilated Critically Ill Patients.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

Please write the paper in APA 7th Edition. Research sources must be 2016-2020 and be peer reviewed. The subject of the proposal is Early Mobilization in the ICU and Ventilated patients.Early Mobilization in the ICU for Mechanically Ventilated Critically Ill Patients.

Executive Summary

Problem Statement

Cases of mechanically ventilated critically ill patients taking long on the treatment without mobilization are on the increase in the organization. This has increased mortality in the unit through thromboembolism and ventilator-associated pneumonia or VAP. Specifically, the prolonged periods of ventilation for these patients has been occasioned by the occurrence of VAP. This has meant that the affected patients take much longer before they could be mobilized, increasing their mortality risk. The incidence of VAP in the organization has reached an all time high within the past six months, and the outcome measure has now become a quality and patient safety issue that requires addressing. Doing this will require the institution of a quality improvement (QI) initiative. VAP is the second most common hospital-acquired infection (HAI) in the US, affecting an estimated 28% of patients on mechanical ventilation in ICUs (Ghezeljeh et al., 2017). This is a summary of the proposed QI initiative for the organization for purposes of securing funding for the project.Early Mobilization in the ICU for Mechanically Ventilated Critically Ill Patients.

Purpose of the Quality Improvement Initiative

Because it has been established that the main reason why patients on mechanical ventilation delay in being mobilized is VAP, the purpose of this QI proposal is to reduce its rate. Achieving a reduction in the rate of VAP in the facility’s ICU will require the use of evidence-based interventions. These are interventions that are backed by current scholarly evidence for efficacy. From current evidence-based practice or EBP, it has been found that the most effective way to reduce the rate of VAP is through a nurse-led bundle. Amongst other measures, this bundle includes:Early Mobilization in the ICU for Mechanically Ventilated Critically Ill Patients.

1. Keeping the critically ill patient on mechanical ventilation in a semi-recumbent or semi-Fowler’s position. In doing this, the head of bed elevation (HOBE) angle must be between 30° and 60° (Ghezeljeh et al., 2017; Hassankhani et al., 2017). This will definitely require more registered nurse full-time equivalents (FTEs) as more nurses will be needed to perform the 2-hourly turning to prevent the development of pressure ulcers in this position.
2. Using chlorhexidine for oral (mouth) wash for all the patients on mechanical ventilation. This can be done every 8 hours to obtain the best results. Studies have found chlorhexidine cheaper and more effective compared to other disinfectants such as povidone in preventing VAP (Álvarez-Lerma et al., 2018; Rabello et al., 2018). Chlorhexidine is a biocide with broad-spectrum activity against bacteria. In this respect, too; there will be a need for more RN FTEs.Early Mobilization in the ICU for Mechanically Ventilated Critically Ill Patients.

The Target Population/ Audience for the Initiative

For this particular QI initiative, the target audience is the entire nursing workforce in the organization’s ICU. These are the employees expected to implement the QI proposal by practicing the EBP interventions of proper positioning and the use of intraoral chlorhexidine. For this reason, the ICU nursing workforce will need to be taken through training lectures that will disseminate the available EBP information on the efficacy of the two interventions. For chlorhexidine, it will also be prudent to invite representatives from the supplying pharmaceutical company to give some lectures on its use in preventing VAP to the ICU nurses.Early Mobilization in the ICU for Mechanically Ventilated Critically Ill Patients.

The Benefits of the QI Initiative

The benefits of the QI initiative will be immense. These will include:

• Early mobilization of patients on mechanical ventilation in the ICU, thereby reducing the mortality rate which is a quality outcome measure.
• A reduction in the incidence of VAP, another quality and patent safety outcome measure.
• A reduction in the hospitalization costs for the patient and better patient satisfaction.

Required Interprofessional Collaboration for Implementing the QI Initiative

Critical care nurses in the ICU do not work in isolation. For this reason, they will need an environment of interprofessional collaboration in order to make this change proposal a success. To begin with, the physicians and other clinicians attending to these mechanically-ventilated patients must not make contrary orders antagonizing the positioning and use of intraoral chlorhexidine. Nurse assistants working in the ICU must also help the critical care nurses to maintain the patients in semi-recumbent/ semi-Fowler’s position. Lastly but not least, the physical therapist must also be at hand to help the nurses mobilize the patients as early as possible.Early Mobilization in the ICU for Mechanically Ventilated Critically Ill Patients.

Cost or Budget Justification

The cost of this QI initiative will be in most part due to the extra FTEs required (i.e. more nurses in shifts in the ICU) and the purchase of the chlorhexidine. The total annual budget for this initiative will thus be $316,160 split as follows:

1. An extra RN in every shift working for 8 productive hours giving a total of 8,760 productive hours annually or an extra 4.2 FTEs. With a pay of $36 per hour, this gives a figure of $315,360.
2. Purchase of chlorhexidine per annum estimated at $800.

Basis of Evaluation

The success of the QI initiative will be evaluated based on data from the organization’s dashboard metrics. This will be data on VAP rates, ICU mortality rate, and number of days stayed in the ICU. A reduction in this will indicate success.Early Mobilization in the ICU for Mechanically Ventilated Critically Ill Patients.