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2019 HSR&D/QUERI National Conference Abstract

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1010 — Implementation of a Department of Veterans Affairs Oral Care Initiative to Prevent Hospital-Acquired Pneumonia Among Non-Ventilated Patients

Lead/Presenter: Shannon Munro,  Salem VAMC; QUERI funding decision pending
All Authors: Munro SC (Salem VAMC), Shannon Munro, PhD, APRN, BC, NP, National Project HAPPEN Implementation Lead, Department of Veterans Affairs Medical Center, Salem, VA; Owais Farooqi, DDS, MDS, VHA Office of Dentistry; Shikha Vasudeva, MD, Infectious Disease, Department of Veterans Affairs Medical Center, Salem, VA; Ryan Vega, MD, MSHA, VHA Innovation Ecosystem Director

The Veterans Health Administration, the largest integrated health care system in the U.S., is constantly seeking to innovate its systems and practices to ensure Veterans receive the highest quality care. One area of need is a lack of effective oral care delivery in hospitals to prevent pneumonia. As part of the Diffusion of Excellence Initiative, VA staff implemented HAPPEN (Hospital-Acquired Pneumonia Prevention by Engaging Nurses), to address this pressing need and reduce the incidence of non-ventilator associated hospital acquired pneumonia (NV-HAP).

A single arm intervention pilot study used pre/post population data to determine the effectiveness of an oral care regimen vs. usual care to prevent NV-HAP on 4 units: two geriatric community living center (CLC) units and 2 medical surgical units (4H and 4J). Incidence rates were compared over time dividing the number of newly diagnosed cases of NV-HAP by the number of admissions (all patients considered equally at risk). Estimates on the predicted cost of hospitalization due to NV-HAP (e.g. $40,000) were used to inform cost analyses.

The incidence rate of NV-HAP on the CLC units decreased from 105 to 8.3 cases per 1,000 patient days (by 92%) during the first year. Likewise, the incidence rate of NV-HAP on 4H and 4J decreased from 1.2 to 0.9 cases per 1,000 patient days (by 38.6%) in year one.

As of December 2018, the implementing units in 8 VA hospitals in North Carolina, Texas, and Virginia reported a predicted 172 cases of NV-HAP prevented with 31 Veteran lives saved as well as $6.88M in estimated cost avoidance.

HAPPEN shows promise as a simple yet innovative practice to enhance the safety and well-being of hospitalized Veterans by reducing the risk of NV-HAP through implementation of effective oral care practices in hospitals at a low cost. Nationwide deployment is in progress with an additional 16 VA facilities in the foundation stages of implementation.