Fort Kent ~ According to the data that the Institute for Healthcare Improvement (IHI) has been tracking across the country since 2008, high performing healthcare organizations who have adopted the Triple Aim quality framework, are reporting healthier populations, in part, because of new designs that better identify problems and solutions further upstream and outside of acute health care. In its second year, Northern Maine Medical Center (NMMC) has embraced the IHI’s quality improvement framework, called the Triple Aim. NMMC expects the Triple Aim framework will: assist individuals in local communities to reach their highest potential for health, support strong financial health, provide consistent high quality services to its patients every time and to be a provider of choice for local residents.
The latest of NMMC’s Triple Aim patient care improvement initiatives is the reduction of acquiring pneumonia in patients who undergo surgery. According to the American Nurse Today, non ventilator associated healthcare acquired pneumonia (HAP) is one of the most common HAP’s in the United States.
In the ongoing review of NMMC’s patient experience data in November of 2016, Sue Devoe, RN, Director of Quality at NMMC, gathered key clinicians from the Quality and Nursing Departments to identify opportunities for improvement in clinical quality indicators. Devoe said, “We do not have many hospital acquired infections but pneumonia is our biggest offender.” With NMMC’s philosophy of zero defects, the intended goal is to educate the staff and implement best practices to prevent hospital acquired post operative pneumonia.
One of the first actions taken by the work group was to conduct a literature search to determine best practices in preventing the incidence of pneumonia.
According to one source, the Journal of Nursing Scholarship, 2014, hospitalization is associated with deterioration in oral health. Hospitalization itself can weaken a patient’s natural defenses and typically disrupts daily care patterns. Patients may lack the energy or desire to perform basic care, such as effective oral hygiene, unless caregivers encourage it and teach them about its importance. Deterioration in oral health status leads to an increased risk for HAP and increased length of hospital stay and cost, and can impact a patient’s well-being and quality of life. It can also lead to hospital readmission.
As a consequence to hospitalization, even healthy adults can be at risk for aspiration of oral secretions and that, combined with decreased mobility, can create optimal conditions for microbes to flourish in the mouth and respiratory tract. Other contributing factors such as: anesthesia, unmanaged pain or medication effects to manage pain all cause patients not to breathe as deeply, therefore causing less lung expansion, setting up a perfect scenario to support the development of pneumonia.
In its research, the work group determined that the single most important factor in the success of pneumonia prevention was through the adoption of basic measures such as oral care, recommended by the American Dental Association and the Center for Disease Control and Prevention Guidelines. NMMC’s HAP prevention program focuses on getting healthcare workers to encourage patients to engage in good oral care after each meal and at bedtime. The prevention program also focuses on strengthening the patient’s bodily defenses by promoting early mobility and encouraging coughing and deep breathing for maximum lung expansion which are also important components of the program.
The special task force has designated the week of January 16 -21 to launch the new program. During the kick off week, all healthcare staff will participate in formal education related to the risk factors for HAP as well as the implementation of a new protocol outlining best practices. Moving forward, all patients scheduled for surgery will receive information about the program to help them understand the importance of each of the actions directed at preventing hospital acquired infection. Devoe said, “We know we are already making a difference in the lives of our patients; we are already seeing fewer cases of postoperative pneumonia but our work does not stop at pneumonia prevention strategies.” The work group has also created an informational brochure outlining ways for patients to participate in staying healthy while in the hospital; all patients admitted to the hospital will receive the information. To learn more about this and other Triple Aim quality initiatives, go to www.ihi.org.
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