Hospital-Acquired Pneumonia Improvement Project

Purpose: The purpose of our project is to reduce the incidence of hospital-acquired pneumonia (HAP) in patient the Antioch population which in turn promotes positive patient outcomes.

Description: The HAP process improvement team implemented oral care practices hospital-wide to reduce the incidence of HAP via ease/accessibility of use, staff education, and daily performance feedback. Based on the research article Quinn et al. the team utilized multiple evidence-based practice methods to reduce HAP incidence. The methods included staff education, easy-to-do interventions involving front-line staff, and process monitoring. The team also developed an oral care practice that could be implemented locally with success. New “all-in-one (toothbrush, toothpaste, spittoon, suction adapter)” toothbrush packs were purchased easing the action of oral care performed by staff and patients. For ease of access, created a uniform area of access on each unit. The centralized location is at the nursing station formatting marked with oral care signage on all units. Education was provided to nursing assistants 1:1 on the following: proper documentation, expectation/frequency of oral care. Expert speakers were invited to educate direct patient care staff during implementation of new oral care products. A debrief system was developed to do a root cause analysis of each HAP. This system was developed to find contributing factors of HAP to prevent re-occurrence. The findings were shared house-wide with front-line staff via interactive shift huddles. HAP process measures were added to the daily huddle board sharing with staff current performance inclusive of mobility, out of bed for meals, and teeth brushing rate. A barrier log was posted to identify opportunities for improvement. Our unit-based team promoted individual recognition when achieving daily goals via huddle call outs. Units achieving monthly goals are also celebrated. Successes are then publicized house-wide.

Evaluation/outcome: The total HAP incidence at the initiation of our project was 15 cases over last 12 months. The rate was at 2.4 HAPs per 1000 admissions. A root cause analysis discovered an opportunity in the implementation of HAP prevention process measures specifically (but not limited to) oral care. Baseline for oral care score was 58% of patients who brushed their teeth twice daily. The goal for oral care percentage was set at 75%. After implementation of the new oral care process, the teeth brushing percentage increased incrementally over the course of 2 months; 68%, 73% respectively. Another HAP prevention measure that was reviewed was out of bed for meals. The initial out-of-bed-for-meals percentage was 25%. After initiation of the project the goal was set to 50%. Our percentage increased accordingly to 40%, 43% respectively. Since the initiation of the project, there have been no new HAP cases and there is a noted reduction in overall HAP rate from 2.4 to 2.35. The expectation based on the recent outcomes is our teams will achieve the goal rate of less than 2 HAP per 1000 admissions in the near future.

Evidence-based references
1. Quinn B, Baker D, Cohen S, Stewart J, Lima C, Parise C. Basic nursing care to prevent nonventilator hospitalacquired pneumonia. Journal of Nursing Scholarship. 2014; 46 (1), 11-19