Implementation and Dissemination of a Department of Veterans Affairs Oral Care Initiative to Prevent Hospital-Acquired Pneumonia Among Nonventilated Patients

Abstract

Implementation and dissemination of an oral care initiative enhanced the safety and well-being of Veterans at the Salem VA Medical Center by reducing the risk of non-ventilator-associated hospital-acquired pneumonia (NV-HAP). The incidence rate of non-ventilator-associated hospital-acquired pneumonia decreased from 105 cases to 8.3 cases per 1000 patient-days (by 92%) in the initial VA pilot, yielding an estimated cost avoidance of $2.84 million and 13 lives saved in 19 months postimplementation. The team was successful in translating this research into a meaningful quality improvement intervention in 8 VA hospitals (in North Carolina, Texas, and Virginia) that has promoted effective and consistent delivery of oral care across hospital service lines and systems, improved the health of Veterans, and driven down health care costs associated with this largely preventable illness. The steps needed for successful replication and dissemination of this nurse-led, evidence-based practice are summarized in this article.

Incidence and risk factors of non–device-associated pneumonia in an acute-care hospital

“…A few recent studies have reported that the use of oral care prevented ND pneumonia in high-risk patients (eg, neurologic injury patients, older adults). [35][36][37] Although we did not detect an association between chlorhexidine mouthwash and ND pneumonia rates, this discrepancy could be due to targeted use of oral care with chlorhexidine at UNC Hospitals. In contrast to its universal use in prior studies, only 8% of hospitalized patients included in this analysis received this treatment.…”

Implementing Oral Care as a Nursing Intervention to Reduce Hospital-Acquired Pneumonia Across the United States Department of Veterans Affairs Healthcare System

“…21,22 Efforts at reduction in NV-HAP incidence have been challenged by limitations in improving the quality and frequency of oral care, often considered to be fundamental care. 8,9,13 Therefore, a critical lesson learned was the need to shift nursing beliefs regarding oral care from solely a comfort measure to an essential infection control practice, which can be tracked and counted as a direct accountability measure for nursing services. As the team began to discuss oral care as a critical and expected standard of care (using handwashing as an analogy), it became less likely to be viewed as optional care.…”

Balancing reality in embedded research and evaluation: Low vs high embeddedness

“…As of the end of fiscal year 2020, DoE estimates that eight National Diffusion Practices have been implemented at numerous facilities across the VHA and impacted an estimated 570 000 veterans in fiscal years 2019 and 2020. Example DoE Promising Practices include (a) enhancing oral hygiene of inpatients with the goal of preventing non‐venerator associated pneumonia 18,19 ; (b) encouraging the early ambulation of hospitalized patients with the goal of preventing functional decline 20‐22 ; and (c) use of automated review of electronic health record data to identify prescriptions that are potential candidates for discontinuation 23…”

“…We end with a set of lessons to consider when conducting embedded projects. non-venerator associated pneumonia 18,19 ; (b) encouraging the early ambulation of hospitalized patients with the goal of preventing functional decline [20][21][22] ; and (c) use of automated review of electronic health record data to identify prescriptions that are potential candidates for discontinuation. 23…”