From the 2024 HVPA National Conference
Maureen Henley MSN (The Johns Hopkins Hospital)
Background
In 2018, the CDC published data reporting Hospital Acquired Pneumonia (HAP) is the #1 Hospital Associated Infection (HAI), with Non-ventilator hospital-acquired pneumonia (NV-HAP) representing at least 60% of the cases₁. The Johns Hopkins Hospital (JHH) had 24 aspiration PNA Maryland Hospital Acquired Condition (MHAC 6) cases in CY22, which was above target. In addition, JHH was financially penalized in CY22 due to our MHAC performance and aspiration PNA performance had a large impact on this penalty.
When conducting a gap analysis, comparing EBP for prevention of aspiration and NV-HAP, our team identified oral care as both effective at reducing NV-HAP and a current gap in our care practices.
Objective
- To reduce aspiration PNA MHAC 6 from 24 observed cases in CY22 to ≤20 in CY23 (outcome measure).
- To improve oral care compliance by 20% by June 30, 2024 (process measure).
Methods
Our multidisciplinary team followed a rapid cycle improvement model that targeted small tests of change. We worked at the hospital level to define the problem and metrics and conduct literature reviews and complete analysis. We then collaborated with unit-level clinicians to identify improvement opportunities and implement changes. At this time, nine adult inpatient units have gone live with oral care pilots.
Results
Overall, our MHAC performance decreased and our oral care compliance increased. MHACs fell from 24 observed aspiration pneumonia cases (MHAC 6) in CY22 to 20 observed cases in CY23. Oral care compliance at the hospital level increased from an average of 19% compliance for documented oral care two times per day to an average of 27% compliance since the first units’ pilot go-live in September 2023.
Conclusions
Implementing oral care in our piloted units has shown to improve our hospital-level outcomes. Next steps include continuing to spread oral care pilots across the hospital while creating standard policy and procedure and EMR support to support sustainability.
Clinical Implications
This initiative improved patient safety in reducing the number of hospital-acquired pneumonia occurrences.