Nursing adherence with evidence-based guidelines for preventing ventilator-associated pneumonia

Objective: To review barriers to nursing adherence to nonpharmacologic evidence-based guidelines for preventing ventilator-associated pneumonia. Design., Descriptive study. Setting. Intensive care units. Subjects:Subjects were 110 nurses approached at two critical care nursing meetings. Interventions: A questionnaire was administered to nurses to assess their adherence to 19 nonpharmacologic prevention strategies and to identify barriers to adherence to evidence-based guidelines. Measurements and Main Results: Fifty-one nurses responded, and overall nonadherence was 22.3%. Significant differences of adherence were identified when compared with the rates previously reported by physicians in nine of the 19 strategies investigated. The most important reasons for nonadherence were unavailability of resources (37.0%), patient discomfort (8.2%), disagreement with reported trial results (7.8%), fear of potential adverse effects (5.8%), and costs (3.4%). Nurses were more likely (p < .05) to identify patient discomfort (odds ratio, 4.8) and fear of adverse events (odds ratio, 3.3), whereas physicians were more likely to report costs (odds ratio, 5.4) and disagreement with interpretation of trials (odds ratio, 3.7) as reasons for nonadherence. Conclusions. Nurses had different levels of adherence than physicians for many nonpharmacologic strategies. The most important barriers to implementation were environment-related. Other reasons for nonadherence show significant variability between nurse and physician opinion leaders, patient-related barriers being significantly more important for nurses. Our findings suggest the need for development of multinational guidelines to reduce variability and the need to include the nursing point of view in these guidelines.