| Principal Investigator: |
| Principal Investigator: | Amy B. Bray, RN, BSN, CCRN |
| Co-Principal Investigators/Collaborators: | Kylee Foy, Mayra Castillo, Ellen J. Angelo |
| Organization: | U.S. Army Institute of Surgical Research (USAISR) |
Abstract
Problem
Lack of oral care compliance may contribute to an increased ventilator associated pneumonia (VAP) rates in the intubated burned population.
Evidence
Our VAP rate from January 2009 to June 2009 was 23% in comparison to the national average of 12%. Per unit policy ventilated patients are required to have two nurse initiated orders (NIO) activated , ‘Swab Oral Cavity Q4 Hours’ and ‘Brush Teeth BID’ within 24 hours of intubation. An automated query of computerized documentation resulted in a compliance rate of 22%.
Strategy
A review of the literature shows a positive correlation between the frequency of oral care and the incidents of VAP. Working with a multidisciplinary team, a formal performance improvement project using the FOCUS PDCA format was developed and implemented.
Practice Change
A massive staff education campaign was launched July 2009 using oral care kit representatives to reinforce the importance of oral care, use of their oral care kit and introduction of an update policy. The campaign included education with a unit appropriate oral care kit. Along with the education came increased staff accountability though positive leadership and more frequent audits. The last practice change was a redefined admission order set of NIO’s.
Evaluation
Random weekly visual audits of kits usage was conducted along with monthly automated queries of the computerized charting.
Results
With the use of an enforceable policy, less complicated means of accessing the correct NIO’s and education have proven to be very effective. In three months oral compliance increased from 22% to 98%. During the same time period our VAP rate decreased from 23% to 7%.
Recommendations
Education, positive management reinforcement and an affable documentation system will lead to staff compliance to meet organizational goals. With the new/reinforced knowledge came heightened awareness from the increased accountability of the project coordinators. When staff is provided with an oral care kit to match the current policy and information on its use their compliance increases.
Bibliography
- Cindy L. Munro, Mary Jo Grap, Deborah J. Jones, Donna K. McClish, and Curtis N. Sessler (2009). Chlorhexidine, Toothbrushing, and Preventing Ventilator-Associated Pneumonia in Critically Ill Adults. Am. J. Crit. Care, 18: 428–437.
- CDC Guidelines for Preventing Healthcare-Associated Pneumonia, 2003. Recommendations of the CDC and the healthcare Infection Control Practices Advisory committee. MMWR 2004;53 (No. RR–3).
- Pear, S, Stoessel, K & Shoemake (2007). The Role of Oral Care in the Prevention of Hospital-Acquired Pneumonia, An Accredited Independent Study guide. Knowledge Network, Kimberly-Clark Health Care Education, p 3–28.
- Robert Garcia, Linda Jendresky, Larry Colbert, Althea Bailey, Mohammed Zaman, and Mujbur Majumder (2009). Reducing Ventilator-Associated Pneumonia Through Advanced Oral-Dental Care: A 48-Month Study. Am. J. Crit. Care.; 18: 523–532.
- Scott J, Vollman K., Procedure 4 Endotracheal tube and Oral Dare. In: Wiegand D, Carlson K, editors. AACN Procedure Manual for Critical Care 5th ed. St. Louis: Elsevier Saunders; 2005 p 28–33.