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J Nurs Care Qual. 2019 Jul/Sep;34(3):223-229. doi: 10.1097/NCQ.0000000000000359.

Sustaining Quality Improvement: Long-Term Reduction of Nonventilator Hospital-Acquired Pneumonia.

Author information

1
School of Nursing, California State University, Sacramento, Sacramento (Dr Baker); Sutter Medical Center, Sacramento, California (Ms Quinn); James Cook University Hospital, Middlesbrough, and Institute for Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom (Dr Ewan); and Northeastern University, and Yvonne L. Munn Center for Nursing Research, Massachusetts General Hospital, Boston (Dr Giuliano).

Abstract

BACKGROUND:

Hospital-acquired pneumonia is now the number one hospital-acquired infection. Hospitals have addressed ventilator-associated pneumonia; however, patients not on a ventilator acquire more pneumonia with significant associated mortality rates.

LOCAL PROBLEM:

In our hospital, non-ventilator-associated pneumonia was occurring on all types of units.

METHODS:

The Influencer Model was used to reduce nonventilator hospital-acquired pneumonia rates. Statistical process control R and X-bar-charts were monitored monthly.

INTERVENTIONS:

After a gap analysis, an interdisciplinary team implemented enhanced oral care before surgery and on the units, changed tube management, and monitored stress ulcer medication.

RESULTS:

We achieved a statistically significantly reduction (P = .01) in pneumonia rates that have been sustained over 4 years.

CONCLUSIONS:

Sustaining change requires (a) a continued team-based, collaborative approach, (b) ongoing stakeholder and executive leadership engagement, (c) monitoring that easy-to-use protocols and required equipment remain in place, and (d) embedded analytics to monitor results over a prolonged period.

PMID:
30198950
DOI:
10.1097/NCQ.0000000000000359
[Indexed for MEDLINE]

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