Boosting Oral Care

in the Neuro
Intensive Care Unit
 Project Team

Emily Hall
Introduction & Quality Improvement
Issue
Dani Dursch-Smith
Testing Changes

Austin Cupryk
Forming the Team & Setting Aim

Amira Soto
Barriers to Implementation & Visual
Aid
Ian Jones
Establishing Measures & Selecting
Changes
Banner University Medical Center: Neuro Intensive
Care Unit
Staff Staff
- Providers (MD, NP)
- RNs
- PCTs
- RTs
-Unit Manager

1625 N
Leadership & Ratios Campbell Patient Population
- Fully staffed is 12 Ave, - Those suffering from
nurses with an ideal ratio Tucson, brain injury, illness,
of 2:1 AZ 85719 tumors & burns who
- Stable Leadership with are hemodynamically
Total Patient Care Model unstable
- 24 bed unit
-
 Quality Issue - Oral Care in the ICU

● Causes
○ Lack of time
○ Nurses’ perception that oral care is a lower priority procedure
● Potential consequences
○ Increased risk of Healthcare Associated Pneumonia
○ Risk for development of sores or other injury to oral mucosa
○ Increased mortality
● Current Steps
○ Current oral care procedure dictates charting for ventilated patients every
4 hours, and charting for non-ventilated patients every shift
○ Send out facility wide handouts
 Model for Improvement: Forming the Team

Unit Manager Nurse Educator

Provides education for

Follows trends in
proper oral care
oral care
Nurse Executive/ performance; educates
Registered Nurse performance
Hospital Director when met with
Implements the resistance
intervention Identifies other
units that have a
higher oral care
performance
 Model for Improvement: Setting the Aim
Effectiveness ✔
Oral care is associated with a
decrease in hospital associated
pneumonia for patients on and
off ventilators (Gershonovitch
et al., 2020; Giuliano et al.,
2021)
Timeliness ✔
Decreased length of stay
due to decreased amount of
hospital acquired conditions
Efficiency ✔
Less supplies and energy
used due to a decrease in
length of stay
✔ Patient-Centered
The aim is centered in
patient needs as oral care is
a simple intervention that
can be easily forgotten
Our
To increase the
Aim
percentage of patients
receiving oral care on
✔ Safety
the Banner UMC neuro Preventing the development
of hospital acquired
ICU to 90% within a
conditions
week of
implementation.
✗ Equity
The aim does not hinder or
enhance equity
 Model for Improvement: Establishing Measures
Quality improvement measure that Benchmark:
will be the focus of the PDSA: One study, Kelly, N,
● Charting Oral Care qshift for every et al. (2023),
patient, and q4h for vented suggests at least 73%
patients. of patients should
● Oral care methods include receive oral care
toothbrushing, foam sticks, within the 24-h
moisturizing the oral cavity, and period as a
mouth rinse with chlorhexidine. benchmark
Unit data:
● March 49.8%, April 39.6%, May
41.9%, June 42.6%, July 47.9%,
August 41.3%
 Model for Improvement: Selecting Changes
Bedside Kits
In the study Kelly, N, et al. (2023)
found that “Oral assessment is
conducted less frequently using
multiple tools.”
● Simple kit stored in the room
will eliminate inconvenience
Teamwork
Delegation
Have nurse perform only vented
patients oral care and delegate half
the oral care to tech,
● Systemic utilization of team
can distribute the load and
limit time constraint
Educate Staff
The study Antonacci, G., et al. (2023)
preformed staff education where 84%
of Staff learned something new
● Study demonstrates the staff
might not know the
importance of oral care
 One change to focus on for PDSA
Continuing Education Programs
● Educate nurses on the importance of
oral care in critical care settings.
● Easy to implement
● The record of activities with oral care
rose from 29.6% to 92.8% in Sánchez
Peña, M., et al. study.
● VAP incidence diminished from 8.9%
to 2.8% after the intervention
(Sanchez Peña et al., 2021).
 Model for Improvement: Testing Changes

Objective Plan
To increase oral care provided ● 2 week planning
PDSA:
by nurses in the ICU to 90% period
PLAN
by increasing education and ● 1 week for nurse
charting on oral care. educator to prepare
● Integrate 12 week
theoretical-practical
sessions

Predictions
Immediate increase in oral
charting within a week, gradual
decrease as time passess.
 Model for Improvement: Testing Changes (cont.)

Do
● Nurses participate in the oral
care program for 12 weeks
● Weekly data extraction
○ Oral Care: PDSA:
Q4H for ventilated DO
patients, Qshift for
every patient.
● Data is collected for 3
months
Model for Improvement: Testing Changes (cont.)

Study
● Data collected weekly for three months
on nurses.
● Should see increase in oral care to
90% within first week of
PDSA: implementation.
STUDY ● Long term–one week out of every six
months will be evaluated.
○ If nurses fail to meet benchmark,
they will be ask to participate in
the practicum aspect of the
curriculum again.
Potential Barriers to Improvement: Microsystems
Staffing Focus:
- Burnout in staff members
- Lack of incentives to get
staff involved in care
Plan:
Increase involvement in the project
by offering incentive to the Neuro
ICU staff.
Interdependence:
- Poor collaboration with other staff
members on the team
- Lack of recognition and
appreciation for fellow team
members
Plan:
Host lunch-in with the unit staff every
month to improve collaboration and
appreciation for one another.
Visual Aid
 References
Albougami, A. (2023). Oral health literacy levels of nursing professionals and effectiveness of integrating oral health training into

nursing curricula: a systematic review. Applied Sciences, 13(18), 10403. https://doi.org/10.3390/app131810403

Antonacci, G., Ahmed, A., Lennox, L., Rigby, S., & Coronini-Cronberg, S. (2023). Oral health promotion in acute hospital setting: a

quality improvement programme. BMJ Journals.

Gershonovitch, R., Yarom, N., & Findler, M. (2020). Preventing ventilator-associated pneumonia in intensive care unit by improved oral care: A review of

randomized control trials. Springer Nature Comprehensive Clinical Medicine, 2(6), 727–733. https://doi.org/10.1007/s42399-020-00319-8

Giuliano, K., Penoyer, D., Middleton, A., & Baker, D. (2021). Original research: Oral care as prevention for nonventilator hospital-acquired pneumonia. AJN,

American Journal of Nursing, 121(6), 24–33. https://doi.org/10.1097/01.naj.0000753468.99321.93

Kelly, N., Blackwood, B., Credland, N., Stayt, L., Causey, C., Winning, L., McAuley, D. F., Lundy, F. T., & Karim, I. E. (2023). Oral

health care in adult intensive care units: A national point prevalence study. Nursing in Critical Care, 28(5), 773–780. https://doi.org/10.1111/nicc.12919

Sánchez Peña, M., Orozco Restrepo, L. A., Barrios Arroyave, F. A., & Suárez Brochero, O. F. (2021). Impact of an educational intervention aimed at nursing

staff on oral hygiene care on the incidence of ventilator-associated pneumonia in adults ventilated in intensive care unit. Investigacion y Educacion en

Enfermeria, 39(3), e06. https://doi.org/10.17533/udea.iee.v39n3e06