Brushing Up on the Root of Healthcare

Project Topic:

Preventing Non-Ventilated Hospital-Acquired Pneumonia

Hospital, City and State:

Bayhealth Sussex Campus, Milford, Delaware

Unit:

5B PCU

CSI Participants:

• Jennifer Klink, BSN, RN
• Casey Miller, BSN, RN, CCRN
• Sophia Perry, BSN, RN
• Lauren Wilcox, BSN, RN

Project Goals/Objectives:

1. Increase incidence of oral care to 75%
2. Increase patient mobility to 80%
3. Decrease the incidence of non-ventilated hospital-acquired pneumonia (NV-HAP) 50%
4. Increase the Healthy Work Environment Assessment Tool (HWEAT) score related to True Collaboration by >=1 point

Project Outcomes:

1. Increased incidence of oral care from 22% to 75%
2. Increased patient mobility from 44% to 54%
3. Decreased incidence of NV-HAP from 4 to 2 cases
4. HWEAT True Collaboration score remained unchanged
5. HWEAT Skilled Communication score improved from 3.68 to 3.79
6. These outcomes resulted in a positive estimated annual fiscal impact of $59,427

Project Overview:

The CSI team noted that our unit has a low compliance rate for completing the basics of healthcare, which we categorized as oral care and ambulation at least once per shift. Lack of oral care and patient ambulation led to four cases of NV-HAP in 2023. Statistically, 1 out of 14 deaths that occur in the hospital are due to NV-HAP despite it being a preventable healthcare-associated infection (HAI). NV-HAP is not currently part of the Centers for Medicare and Medicaid Services HAI program; thus, it is underreported, and most hospitals have no preventative policies. In addition to standardizing basic preventative care, the team noted a need for increased education and awareness of the harmful bacteria and biofilm that grow in the mouth and enter the airways.

Our Progressive Care unit treats patients with a wide range of diagnoses including patients who are tracheostomy-ventilator dependent. We have a mix of independent and total care patients. Therefore, we want our practice to reflect patient-specific needs. As part of our project, the CSI team asked our unit colleagues to give a toothbrush to independent patients and walk them to the bathroom at least once a shift. The CSI team requested that total care patients be placed in chairs when appropriate and oral care provided twice per shift using specific supplies based on their requirements.

The CSI team created a project logo and slogan and placed these on badge reels and pens throughout the unit as a visual reminder of the project. We created an education binder with our project plan, goals, and current progress of our compliance. Unit charge nurses audited charts and made staff aware of missed oral care and undocumented ambulation per shift. Our group also met with an equipment representative to discuss current oral care supplies and the possibility of acquiring new materials to aid in proper oral care.