Costs. Length of stay. Patient mortality. We know that the care we provide is central to good outcomes of every kind. But how often do we get to clearly demonstrate this for hospital administration? In “A Nurse-Driven Oral Care Protocol to Reduce Hospital-Acquired Pneumonia” (free until March 1) in this month’s issue, authors Chastity Warren and colleagues describe a QI project that showcased how a simple nursing intervention decreased morbidity, mortality, and costs at their hospital.

A standardized oral care protocol.

Aware of the connection between poor oral care and hospital-acquired pneumonia, a group of nurses at their large Midwest hospital set out to devise a standardized oral care protocol for all adult patients. Patients were categorized as either ventilated, at-risk (for example, someone with a trach or with swallowing difficulties), or short-term care. The care kit and the frequency of oral care were different for each group.

Once the intervention was in place, the nurses tracked not only the incidence of hospital-acquired pneumonia in both ventilated and non-ventilated patients, but also (by creatively “triangulating” several sources of data) the adherence of staff on each unit to the protocols.

Protocol adherence.

Regarding protocol adherence—always a challenge with new protocols when multiple units and staff are involved—the authors noted that there’s still work to be done:

“While the overall adherence to protocol by nursing staff was respectable (76%), staff adherence did vary across units, suggesting the need for ongoing, targeted feedback and additional staff education.”

Improved outcomes, decreased costs.

Excellent oral care is an often-ignored nursing task in these high-tech days, despite the fact that it makes a huge difference in patient comfort. (Those of us who have spent time immobilized in a hospital bed can attest to this fact.)

As these nurses have illustrated, oral care affects patient morbidity and mortality. Even without perfect protocol adherence, nurses at this hospital were able to improve pneumonia outcomes and decrease costs.

Their efforts transformed “a relatively simple, overlooked nursing intervention into a high-priority, high-impact daily intervention tailored to the needs of hospitalized patients.”

Read about this QI project in the Cultivating Quality department in this month’s AJN.