Nurs478 Quality Improvement Project Final

Oral Care for ICU Patients

Daisy Ahedo, Rhianna Cain, Victoria Itule, Ethan Viator, Melina Barragan
Located in Tucson

Unit 8NS
● ICU: Neuro, Medical, Surgical,
Banner University Trauma, and Burn
● 24 Bed Unit
Medical Center ● Ideal Census: 12 nurses, 2 PCTs
● Ratios:
Tucson ○ 1:2 ICU
○ 1:3 PCU
● Total Patient Care + Team/Modular
Nursing
Quality Issue

Oral Care
● Oral care statistics decreasing steadily since beginning of the year
● Hospital acquired pneumonia (HAP)/other adverse events secondary to
decreased oral care increase
Unit Initiatives
● Push for documenting oral care BID
● Incentives for accurate up to date charting
● Daily unit reminders to document all personal care
Model For
Improvement ● Charge nurses
Forming the Team ● Nurse educators
● Staff nurses
● Respiratory therapists
(Centers for Disease Control and Prevention, 2023)

Our Aim:
Model For Decrease incidence of Hospital-
Acquired Pneumonia (HAP)
Improvement
among ICU patients of all age
Setting Aims groups, by 20% within 6 months
with the implementation of oral
care interventions.
Model For Improvement: Establishing Measures
● Quality Improvement Outcome Measure:

○ Hospital acquired pneumonia in the ICU
● Current Unit Data:

○ Average over the past 8 months = 44.3%
● National Data:
○ 5-10 per 1000 patients develop HAP.
○ Affects 10-20% of mechanically vented patients.
○ HAP can be reduced by 40-60% through oral care protocols.
(Shebl & Gulick, 2023) & (Centers for Disease Control and Prevention, 2023).
● Enforce pre-existing oral care
Model For protocols
Improvement ○ Focus on ICU floors that
have lower compliance
Selecting Changes ● Improve compliance
○ Focus on barriers
(Williams et al. 2023)
● Increase charting
Model for Improvement: Testing Changes
Objective: Plan:
● Decrease incidence of Hospital- ● One week period of planning with team

Acquired Pneumonia (HAP) among ● One week for educating staff, daily
ICU patients of all age groups by reminders
increasing the compliance of oral care ○ Interactive online training
administration. ○ Flyers
○ Daily reminders during huddle
● Oral care supplies in patient rooms
● Incentives for staff
(Williams et al., 2023)

Predictions:
Model For
Improvement ● Overall increased
compliance in oral care
Testing Changes administration
○ Documentation
● Decrease in HAP infections
● Potential supply issues
Model for Improvement: Testing Changes
Do: Study:
● Oral care BID ● Oral care compliance post interventions

○ initial assessment, HS ● Weekly incidences of HAP
● Feedback system (hand-off report) ○ Association between oral care compliance
and HAP rates
● Data collection
● Charting on oral care
● Baseline data on oral care compliance,
● Units where oral care compliance may
HAP rates
be lower
● Availability of resources
● Challenges presented
● Weekly audits
● Feedback
(Munro, 2018)
Act:
Model For
● Adjustments to staff
Improvement training/education
Testing Changes ● Identify challenges and
provide support to overcome
barriers
● Addressing specific areas/units
where compliance may be
lower
Potential Barriers to Implementation: Microsystems
● Staff Focus → Conflicting priorities

○ Plan: Implement targeted education and awareness program for ICU staff that
emphasizes the importance of oral care in reducing hospital-acquired
pneumonias.
● Leadership → Inadequate leadership involvement can cause a hindrance to
implementation of quality improvement initiatives for oral care in ICU
○ Plan: Present evidence-based data and emphasize impact of oral care on
pneumonia rates and patient outcomes.
Visual Aide
References
Centers for Disease Control and Prevention. (2023). Oral health in healthcare settings to prevent pneumonia toolkit.
https://www.cdc.gov/hai/prevent/Oral-Health-Toolkit.html
Munro, S. & Baker, D. (2018). Reducing missed oral care opportunities to prevent non-ventilator associated hospital acquired pneumonia at
the Department of Veterans Affairs. Applied Nursing Research, 44, 48-53. https://doi.org/10.1016/j.apnr.2018.09.004
Shebl, E., & Gulick, P. G. (2023). Nosocomial pneumonia. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK535441/
Williams, B., Shelley, P. D., Patel, V., Prothro, C., & Reynolds, S. S. (2023). Using PDSA cycles to improve oral care compliance. American
Journal of Infection Control, 51, 110-113. https://doi.org/10.1016/j.ajic.2022.05.006

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Oral Care for ICU Patients

(Centers for Disease Control and Prevention, 2023)

● Quality Improvement Outcome Measure:

● Current Unit Data:

● Decrease incidence of Hospital- ● One week period of planning with team

(Williams et al., 2023)

● Oral care BID ● Oral care compliance post interventions

● Staff Focus → Conflicting priorities

Journal of Infection Control, 51, 110-113. https://doi.org/10.1016/j.ajic.2022.05.006

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