| Description |
My project is centered around assessing current NIV (BIPAP) practices within healthcare settings to which I am exposed through my clinical rotations. I proposed to evaluate current literature with evidence-based practice to compare with my findings with respect to facility practices. Ideally, it would be best to seek out functional models where well-established practices exist, assess the variables which make it successful in an attempt to emulate components for less prepared facilities. Endotracheal (ET) intubation is often associated with increased cost, risk and potential patient complications. A substantial number of investigational studies have identified numerous benefits associated with the appropriate use of Noninvasive Ventilation (NIV), with several diverse and specific patient populations. Identified benefits may include, but are not limited to: improved patient outcomes along with reductions in intubation rates, duration and associated costs however, despite related findings, NIV reportedly remains to be significantly underused by many professionals in capable healthcare institutions. Objectives include: Research current NIV indications, compile data, provide up-to-date evidence-based data and outcomes. Re-familiarize clinicians with NIV indications through discussions, lecture and poster presentation. Encourage the use and aid in the development of Non-emergent intubation checklists and NIV algorithms. Encourage clinicians to lead protocol development and include NIV teaching and continued demonstration to employees & students. Current literature provides numerous well-supported indications for NIV and indicates that NIV is underutilized in as much as 42% of US hospitals and acute care settings. Research has identified several limitations or barriers preventing adoption of NIV use. Research has also demonstrated a host of advantages such as significantly improved patient outcomes, reductions in endo-tracheal intubations and complications, as well as reductions in length of stay and associated costs. Research has provided well-established criteria for NIV use, parameters for implementation along with absolute contraindications for use. A comprehensive analysis of current NIV research was completed with comparisons of utilization rates, indications, contraindications, barriers, and algorithms in use. NIV (BIPAP) practices were evaluated at Intermountain medical center. All collected information was reviewed with content experts and experienced professionals such as MD's, (anesthesiologists, pulmonologist, & ER physician), DO's, CRNA's and Paramedic. A presentation and questionnaire specific to NIV along with key findings was presented to Clinicians on March 12, 13 and 14, 2013. With their assistance, an non-emergent checklist and NIV (BIPAP) algorithm was developed. Evaluation of responses to the questionnaire and presentation was subsequently completed with acceptance of requests for further teaching to associated professionals with the intent to promote change with credentialing and practice. |
