Oral care practice guidelines for the care-dependent hospitalized adult outside of the intensive care unit setting

Oral Care Practice Guidelines for the Care-Dependent Hospitalized Adult Outside of the Intensive Care Unit Setting by Cynthia S. Drapal MSN, University of Phoenix, 2011 BSN, Nova Southeastern University, 2009 Doctoral Study Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University June 2015 Abstract Many nurses lack evidence-based knowledge to deliver appropriate oral care, view oral care in the care-dependent patient as a comfort measure, and give it a low clinical priority. An estimated 44%-65% of hospitalized care-dependent patients do not receive adequate oral care, an intervention that can prevent aspiration pneumonia or pneumonitis. The purpose of this project was to develop a policy for use of an oral assessment tool and evidence-based guidelines for oral care in hospitalized care-dependent adults outside of the intensive care unit setting at a regional health system in the Southeast United States. The project used the theoretical foundations of relationship-based care and the logic model. A 14 member interdisciplinary team of institutional stakeholders from 2 acute care hospitals identified an evidence-based oral assessment tool, developed policy and practice guidelines to inform oral care, and developed both implementation and evaluation plans to pilot the project. The short-term goal of the project was to increase staff knowledge, evaluated with direct observation of assessments and documentation reviews. The long-term goal of this project was to reduce the risk of aspiration and resulting complications as evidenced by discharge diagnosis. The standards developed in this project create a process to ensure that care-dependent adults outside of the intensive care unit setting will receive an oral assessment daily, or every shift, as determined by the oral assessment score. The project advances nursing practice by addressing a gap in practice and promotes positive social change by improving the quality of care provided to all care-dependent patients. Improvement of patient outcomes from reduced risk for aspiration and reduced financial burden of unnecessary resources used to care for patients who aspirate and suffer complications are additional outcomes expected of this initiative.Many nurses lack evidence-based knowledge to deliver appropriate oral care, view oral care in the care-dependent patient as a comfort measure, and give it a low clinical priority. An estimated 44%-65% of hospitalized care-dependent patients do not receive adequate oral care, an intervention that can prevent aspiration pneumonia or pneumonitis. The purpose of this project was to develop a policy for use of an oral assessment tool and evidence-based guidelines for oral care in hospitalized care-dependent adults outside of the intensive care unit setting at a regional health system in the Southeast United States. The project used the theoretical foundations of relationship-based care and the logic model. A 14 member interdisciplinary team of institutional stakeholders from 2 acute care hospitals identified an evidence-based oral assessment tool, developed policy and practice guidelines to inform oral care, and developed both implementation and evaluation plans to pilot the project. The short-term goal of the project was to increase staff knowledge, evaluated with direct observation of assessments and documentation reviews. The long-term goal of this project was to reduce the risk of aspiration and resulting complications as evidenced by discharge diagnosis. The standards developed in this project create a process to ensure that care-dependent adults outside of the intensive care unit setting will receive an oral assessment daily, or every shift, as determined by the oral assessment score. The project advances nursing practice by addressing a gap in practice and promotes positive social change by improving the quality of care provided to all care-dependent patients. Improvement of patient outcomes from reduced risk for aspiration and reduced financial burden of unnecessary resources used to care for patients who aspirate and suffer complications are additional outcomes expected of this initiative. Oral Care Practice Guidelines for the Care-Dependent Hospitalized Adult Outside of the Intensive Care Unit Setting by Cynthia S. Drapal MSN, University of Phoenix, 2011 BSN, Nova Southeastern University, 2009 Doctoral Study in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University June 2015 Dedication I dedicate this project to my husband Joe, without whose support I would have never achieved my goal. Acknowledgements I would like to recognize and thank my faculty committee members Dr. Eric (Stoerm) Anderson, Dr. Joan Moon, Dr. Jonas Nguh, and my preceptor Dr. Kimberly Guthrie for sharing their wisdom, providing me support, and providing encouragement throughout the course of my project. I would also like to thank the interdisciplinary project team that helped to bring this project to life: Jennifer Blue, MSN, RN; Sylvia Brown, RN, BSN, CMSRN; Nicole Caldwell, RN; Asha Chandran, RN-BSN,CMSRN; Nicole Chudzik, RN; Diane Clifton, RN, MSN; Laurie Grabowski, C.N.A.; Robert Haas, RN, CNRN; Sarah C Holton, BSN, RN, MBA; RyAnn Jeffery, MS, CCC-SLP; Anna Marie McCarthy, RN, BS, MBA; Nirav Patel, DMD; Sharon Rothwell, RN, MSN, ARNP; and Tracie C Starling, DMD.