Standardizing oral care practices to address non-ventilated hospital-acquired pneumonia: a best practice implementation project

INTRODUCTION: Oral care is frequently missed during a patient's hospitalization, and this continued pattern can lead to adverse outcomes, such as increased non-ventilated hospital-acquired pneumonia (NV-HAP) incidence. OBJECTIVE: This evidence implementation project aimed to address NV-HAP in a large academic medical center. METHODS: The JBI Evidence Implementation Framework was used to guide this project. Following a baseline audit using five evidence-based criteria, barriers to best practice were identified, namely, lack of knowledge of oral care practices, availability of supplies, and missing electronic health record (EHR) fields. Strategies used to address the barriers included staff education, collaboration with material management to procure new supplies, and partnership with clinical informatics to create new EHR fields specific to oral care. Three follow-up audits were conducted to measure improvements in compliance. RESULTS: The baseline audit indicated poor compliance with best practices. After implementing improvement strategies, follow-up data showed overall improvement in four of the five audit criteria. The number of aspiration pneumonia not present on admission (NPOA) decreased by 32 cases over the 4 months after implementation. CONCLUSIONS: A standardized oral care workflow can effectively maintain oral hygiene for patients in acute and transitional care units. Clinical audits, staff feedback, and ongoing education can improve compliance with oral care practices, such as twice-daily teeth brushing, denture sanitation, and par-level maintenance of oral care supplies. An area of opportunity was the consistent usage of patient safety signage for the prevention of aspiration events. Sustained focus on all criteria remains necessary to optimize adherence and reduce the risk of NV-HAP. SPANISH ABSTRACT: http://links.lww.com/IJEBH/A609.