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

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.