Spreading the News: Prevention of Hospital-Acquired Pneumonia is Possible

Abstracts from the Kaiser Permanente2018 National Quality Conference


Cristine Lacerna, RN, MPH, CIC; David Witt, MD, FIDSA; Lawrence Block,
Quality Oversight Support; Donna Patey, RN, CNS, WOCN


From Northern California

Background: A mortality review of hospitalized patients undertaken in 2008 identified hospital-acquired pneumonia (HAP) as a significant contributor to disability and death in the Northern California Region. A subsequent review done in 2012 showed that patients with HAP had longer hospital lengths of stay (an average of two weeks), were more likely to be discharged to skilled nursing facilities instead of home, and were six times more likely to die in the hospital. There were significantly more patients with HAP than those with ventilator-associated pneumonia (VAP). They were more likely to be recovering from routine surgery, elderly, tube-fed, or sedated than patients without pneumonia.
Methods: From 2010 to 2011, the HAP Prevention bundle was tested in pilot sites across the Region. We deployed the bundle to all sites in 2013. Interventions included patient ambulation, upright posture for meals, oral antiseptics, regular incentive spirometry, and reducing the use of sedatives. Decision-support tools were developed, such as banners that alert nurses that a patient is a pneumonia or aspiration risk, as well as a pneumonia provider order set. Reports on performance in the prevention measures were distributed regularly. Collaboration with perioperative teams allowed the inclusion of incentive spirometers in the scheduling kit for surgical patients. HAP was the outcome and confirmed by a natural language extraction algorithm from the radiology result identified as a new opacity, sustained for 24 hours in a chest x-ray obtained 48 hours after hospital admission. Process measures include ambulation rate, compliance with oral chlorhexidine, and benzodiazepine usage.
Results: In 2017, we reduced our HAP by more than 60% from a rate of 7.1 per 1000 admissions to 2.3 per 1000 admissions. Since the implementation, an estimated 308 deaths were prevented and 22,944 patient days saved.
Discussion: HAP was the leading cause of avoidable mortality in the Northern California Region. The reduction was substantial and addressed a risk lacking clinical practice guidelines and having a limited literature to base prevention practices on. This program fits perfectly with the Kaiser Permanente’s mission to “provide high-quality, affordable health care services and to improve the health of our members.” Preventing a hospital-acquired infection, such as pneumonia, demonstrates our commitment to high-quality care. Health care is made more affordable by preventing complications and associated increased lengths of stay. This project aligns with the organization’s mission on affordability by decreasing significant patient morbidity and mortality.

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