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

Lookup NU author(s): Dr Vicky Ewan


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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.

Publication metadata

Author(s): Baker D, Quinn B, Ewan V, Giuliano KK

Publication type: Article

Publication status: Published

Journal: Journal of Nursing Care Quality

Year: 2019

Volume: 34

Issue: 3

Pages: 223-229

Print publication date: 01/07/2019

Online publication date: 06/09/2018

Acceptance date: 05/07/2018

ISSN (print): 1057-3631

ISSN (electronic): 1550-5065

Publisher: Lippincott Williams & Wilkins


DOI: 10.1097/NCQ.0000000000000359

PubMed id: 30198950


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