The Effectiveness of a Ventilator Care Bundle Protocol in Decreasing Incidence of Ventilator-Acquired Pneumonia: A Scoping Review

Purpose/Background Ventilator-acquired pneumonia (VAP) is a preventable hospital-acquired infection with a high mortality rate. Ventilator care bundles (VCB) are implemented to decrease the risk of infection while patients are mechanically ventilated. The aim of this scoping review was to assess how adult patients in the intensive care unit (ICU) requiring mechanical ventilation and the incidence of VAP are affected by staff’s compliance to a VCB. Methods From August of 2022 to November 2022, literature research was done among databases such as PubMed, MEDLINE, and CINAHL. The systematic search in PubMed yielded 55 results with the headings of “(ventilator) AND (care bundle) AND (pneumonia)”. 43 articles were excluded due the inclusion of non-adult patients. From the 12 articles remaining, only 3 from PubMed were relevant. 7 articles from similar searches were also included. The final 10 articles went through rapid critical appraisal and the primary outcomes were synthesized in a data table. Results 2 systematic reviews, 1 controlled trial without randomization, 6 case-control studies, and 1 quality improvement project were included. Each article provided evidence supporting staff compliance with a VCB improved patient outcomes. These outcomes include decreased incidence of VAP, hospital and ICU length of stay, and patient mortality. Implications for Nursing Practice A VCB is a feasible protocol to improve patient outcomes. Prioritization of these interventions decreases incidence rates of VAP. All staff caring for ventilated patients should be educated on the success of VCBs to ensure appropriate compliance and improve patient outcomes

Evaluating the Efficacy of Medication-Assisted Treatment for First Episode Psychosis: A Scoping Review

Purpose/Background The Substance Abuse and Mental Health Services Administration (SAMHSA) recommends that individuals with substance use disorder (SUD) receive medicated-assisted treatment (MAT), as a complete approach to substance use treatment (SAMHSA, 2019). However, treatment measures using combination treatment for SUD in individuals experiencing first episode psychosis (FEP) are seldom used. This scoping review assesses the efficacy of MAT in conjunction with antipsychotics compared to the use of antipsychotic monotherapy for FEP individuals on hospital readmission rates. Methods The authors conducted a literature review utilizing PubMed, EBSCO, Elsevier, Google Scholar, PsychINFO, and Medline from August 2020 to November 2022. Key phrases in the database search included: first-episode psychosis, comorbid substance use, alcohol use disorder, cannabis use disorder, medication-assisted treatment, buprenorphine, methadone, and antipsychotics. Eligibility criteria included individuals experiencing psychosis defined by hallucination, delusion, or paranoia symptoms with co-occurring substance use. Inclusion criteria include publication within the past five years, English or available English translation, full text, institutional review board-approved, and peer-reviewed. Ultimately, we selected ten articles for this scoping review. Results The ten articles demonstrated improvement of psychotic symptoms but showed mixed results in hospital readmission rates after combination therapy. The most notable restriction for this review was the paucity of published literature on MAT for FEP and comorbid substance use. Of the literature reviewed, patients experiencing comorbid FEP and SUDs were vulnerable to poor outcomes due to the illnesses, limited treatment options targeting both symptoms, and poor retention rates in MAT programs. Implications for Nursing Practice This scoping review highlights the treatment of comorbid SUD and FEP with the use of MAT to potentially reduce hospital readmission rates. There was insufficient evidence to outline targeted treatment regimens for our patient population; therefore, more research is needed in this area