2005 OPEN FORUM Abstracts
GETTING COMPLIANCE: A RESPIRATORY THERAPY INITIATIVE TO TAKE OWNERSHIP OF ORAL CARE IN CRITICAL CARE SETTINGS.
Lisa Crouch, RRT, Manager, respiratory therapy, Rick Weber, RRT, Team leader, respiratory therapy, Methodist Dallas Medical Center, Dallas, Texas
Background: Ventilator-associated pneumonia (VAP) contributes to increased ventilator days, critical care and hospital length of stay, costs and mortality. Methodist Dallas Medical Center's VAP rates were higher than the NNIS mean for the adult ICU (Med/Surg), CCU (Cardiac) and NCCU (Neuro). Although a q2 oral care protocol was in place, compliance was a challenge for nursing staff due to product packaging options and competing staff priorities. Methodist Health System recognized an opportunity for improvement and asked respiratory therapy to assume ownership of the oral care protocol to improve patient outcomes.
Methods: Respiratory Therapy adopted a new product packaging along with the oral care protocol in September 2004. Compliance with the oral care protocol has been monitored for 7 months by respiratory therapy beginning in October of 2004 by chart and documentation review. VAP rates have been monitored by Infection Control staff and NNIS definitions.
- For the first 2 quarters of 2004, VAP rates were above the NNIS mean for all adult critical care areas.
- After implementation of oral care protocol during quarter 3, 2004, VAP rates dropped dramatically in quarter 4 of 2004 resulting in all unit VAP rates falling significantly below NNIS mean.
- Quarter 1 of 2005 continues to demonstrate VAP rates well below the NNIS mean.
- Oral care protocol compliance by the respiratory therapists has been between 82-98% consistently for 7 consecutive months.
- Strict compliance with oral care protocols reduce VAP rates
- The respiratory therapist's ownership for oral care protocols are beneficial
- Measured success gives recognition to respiratory therapy services and validates the importance and necessity of the RT role, and when expanded, ensures enhanced quality outcomes
- Ease of packaging and accessibility of required equipment enhances compliance