Roster

Oral Care Project Workgroup

Name Discipline Title/Role Department

Angela Frye, RN, BSN, CNRN Nursing Nurse Manager 7 South

Talwanda Bragg, MD Medicine Physician Internal Medicine

Laurel Packard, OTD, OTR/L BCPR, CBIS

Therapy Occupational Therapist

Rehabilitation Services Administration

Amy Freas, MA CCC-SLP Therapy Speech Therapist Butterworth Speech Therapy

Rebekah Green, MA CCC-SLP Therapy Speech Therapist Butterworth Speech therapy

Erica Newberg, MA CCC-SLP Therapy Therapy Supervisor

Rehabilitation Services Administration

Evidence EP12-1, A3 Oral Care Project and Timeline

HEAL the whole person * ACCESS within 48 hours * OWN the cost of careSite/Location: Revision:

Who Status

AFRYE, AF,

LP, EN

5. HYPOTHESIS 8. CONFIRMED STATE STUDY

Metrics

Baseline

(6 months)

3 months

post

intervention

6 months post

intervention

# of NV-HAP cases on 7S8 2 4

Oral care documented

(note in chart/pt days)1475/2662=

.55

1131/1644=

.68

1647/2729=

.60

Staff feel like oral care is

important 100% 100% 100%

Staff have received oral

care education 57% 100% 100%

Staff are comfortable with

oral care edu.43% 89% 89%

Readmissions (from 7S)

with PNA3 0

0 (at 5 month

mark)

6. EXPERIMENTS DO

1

SIPOC - Tool to ID Key Players

2 a. Just Do Its

b. Projects

c. RIE

cases/6 month period

100% of 7S clinical staff (nursing, NT, OT, MD, APP)

indicate that they complete regular oral care (survey)Survey

Develop oral care process for

7S use.

50% decrease in readmissions (discharged from 7S) who

are diagnosed with PNA

75% of patients on 7S with oral care completion

documented at least 3x/day

number of records/6

months

100% of 7S clinical staff (nursing, NT, OT, MD, APP) feel

that oral care is important (per survey)Survey

Ke

y Strategie

s

3. FUTURE STATE PLAN

100% of 7S clinical staff (nursing, NT, OT, MD, APP) who

feel that oral care is importantSurvey

Number of readmissions (discharged from 7S) who are

diagnosed with PNA3 cases/6 month period

Current State Metrics

57% of 7S clinical staff (nursing, NT, OT, MD, APP) feel that

they have received education on oral care.Survey

9. LESSONS LEARNED ACT

4 orders/6 month period

Number of patients with oral care completion

documented

1475 records of oral care/2662

patient stay days (oral care

completed.55x/day)

2. CURRENT STATE PLAN

2/9

/20

16

Cre

ation

D

ate:2

/8/2

01

6

cases/6 month period

75% of patients on 7S with orders for oral care in Cerner. orders/6 month period

°Oral care is consistently completed 4x/day (per Cerner Documentation).

° 50% decrease in cases of non-vented -health care acquired pneumonia (NV-HAP) and

aspiration PNA on 7S.

°100% of 7S clinical staff (nursing, NT, OT, MD, APP) feel that regular oral care for non-

vented patients is important (per survey).

°100% of 7S clinical staff (nursing, NT, OT, MD, APP) feel that they understand why

regular oral care is necessary.

° 100% of 7S clinical staff (nursing, NT, OT, MD, APP) feel that they complete regular oral

care with non-vented patients on 7S.

Future State Metrics Goal UOMNumber of NV-HAP and aspiration PNA cases on 7S

decreased (50%) from previous metrics.

Cu

rren

t Re

vision

D

ate:2

/16

/20

17

Discharge from 7S

Current UOM

Number of NV-HAP and aspiration PNA cases on 7S. 8 cases/6 month period

Number of patients with orders for oral care

TEAM

: Heath

Biller, H

ann

ah B

ou

ck, Ash

ley Bro

wer, K

elly Sue C

lahassey, D

an G

allivan, Em

ily Ko

smicki, Lisa K

ramer,

Maria Licari, K

elly Mih

alik, Ch

ristine P

LAM

ER, B

tahan

y Kersjes, A

man

da R

ice, Talwan

da B

ragg, Srah A

nd

erson

, Reb

ekah

Green

In Scope (Major Includes) Out of Scope (Major Excludes)

All non-vented patients on 7S Vented patients on 7S

Patients in BW hospital outside of 7S

°Oral care not consistently completed.

° 8 cases of non-vented -health care acquired pneumonia (NV-HAP) and aspiration PNA on 7S from Aug. 2015

to January 2016.

°100% of 7S clinical staff (nursing, NT, OT, MD, APP) feel that regular oral care for non-vented patients is

important (per survey).

°57% of 7S clinical staff (nursing, NT, OT, MD, APP) feel that they have received education on oral care.

° 43% of 7S clinical staff (nursing, NT, OT, MD, APP) feel that they feel comfortable with the education on oral

care they have received.

Present survey questions to 7S

staff via email, presentation at

Shared Leadership, or staff

room paper survey

AF, LP, EN

Completed (end)Admission to 7S

Trigger (start)

AF, EN, RG,

LP

Develop staff reminders to

document/complete oral careAF, EN, LP

PLAN

A3 Description: Oral Completion on 7S (non-vented patients) Exec. Sponsor(s): Butterworth Hospital-7S

Steering

Committee:Angela Frye RN, Talwanda Bragg, MD

A3 Owner(s):

1. BUSINESS CASE PLAN 4. GAP ANALYSIS PLAN 7. COMPLETION PLAN DORegular oral care is not being completed on non-vented patients admitted to the unit 7S at Butterworth

Hospital. Current literature indicates that insufficient oral care in patients increases risk of Non Vented-

Healthcare Acquired Pneumonia (NV-HAP)1,2. If we do not address oral care on 7S, we may continue to see

preventable NV-HAP and aspiration PNA cases, causing extra days in the hospital and decreased patient

experience at the expense of Spectrum Health.1 Quinn B, Baker DL, Cohen S, Stewart JL, Lima CA, Parise C. Basic nursing care to prevent nonventilator

hospital-acquired pneumonia. J Nurse Scholarship. 2014 Jan;46(1):11-9.2 Robertson T, Carter D. Oral intensity: reducing non-ventilator-associated hospital-acquired pneumonia in

care-dependent, neurologically impaired patients. Can J Neurosci Nurs. 2013;35(2):10-7.

Action Item-What

Education, both hands on and SHLIO module is effective

for a large group.

Be explicit with education on oral care and provide the

right tools to get the job done.

Stock supplies on easy to access areas of the nursing unit

for follow through.

What did we learn…

What went well…

Develop Staff survey (50)

Don Packard

Laurel Packard, Amy Freas, Erica

Newberg Sensei:

Use materials that are correctly packaged (2 tooth

brushes) to avoid waste (no need for swabs).

If We… Then We Expect… °Oral care is more consistently completed.

° 4 cases of non-vented -health care acquired pneumonia (NV-HAP) and

aspiration PNA on 7S from Dec. 2016 to April 2016; this is down from 8 cases.

°100% of 7S clinical staff (nursing, NT, OT, MD, APP) feel that regular oral care

for non-vented patients is important (per survey).

°100% of 7S clinical staff (nursing, NT, OT, MD, APP) feel that they have received

education on oral care.

° 89% of 7S clinical staff (nursing, NT, OT, MD, APP) feel that they feel

comfortable with the education on oral care they have received.

»Determine a standard frequency for

oral care…

»If we develop a tool determining the

right oral care techniques...

»If we educate on the importance, risks

associated and impact of regular oral

care…

»If determine the best location to

document oral care completion, for all

staff...

»If we place an order for oral care (via

power plan, etc)...

»If we educate on proper techniques,

methods and tricks to completing oral

care...

«We will see the incidents of oral care

increase.

«We will see less confusion on what

techniques to use with different patients.

«We will see more priority placed on oral

care, and increased incidents of completion.

«We will see more incidents of oral care

completion documented.

«We will see increased completion of oral

care.

«We will instill greater confidence and

competence in staff for oral care completion

with complex patients.

Send staff survey to therapy

Send survey to Hospitalists

Develop focused education on

importance of oral care

AF, LP, RG, EN

AF

AF

1. D

rive Exceptio

nal V

alue, 2

. Transfo

rm th

e Care M

od

el, 3. Lead

New

Health

So

lutio

ns, 4

. Gro

w w

ith P

urp

ose

How--Using real-time hands-on

training, coupled with SHLIO modules.

Experiment--Develop a focused

oral care training for bedside nursing, therapy, and medical providers. Cover techniques,

importance and methods.

Results--Increased documented oral care and increased comfort with oral care education per survey.

Measure--Use survey

previously sent to clinical staff on 7S and documentation of

completion in EMR..

VSA

SIPOC

A3

SIPOC

A3

Oral care

Material:

-What should we use, TB, Sage kit or rinse?

-Where should we store these things?

-How do we stock so we don't run out?

Man:

-Uncertain how to handle complex patients

-need more in-depth education

-don't know how to manage oral care with patients requiring feeding.

-Need to understand importance and risk of not completing.

-Therapy staff need to understand nursing procedures

Machine:

Measurement:

-How much time will this take ifpatients also nee d to be fed?

-No data to understand performance

Method:

-No standard oral care frequency

-What to do with confused/refusing patients

-Should we use orders?

-Which order should we use?

-Where should we document this?

-Where should other disciplinesdocument this?

Mother Nature:

Experiment--Develop an

oral care protocol; include frequency, mode, procedure

and documentation.

How-Procedural document, explaining steps and provides decision tree for appropriate

mode/techniques.

Measure--Increased oral care orders in chart,

increased Sage kit usage.

Results--Increased

documented oral care, increased orders for oral care, and increased Sage kit usage..

Spectrum Health Performance Improvement System (SHPIS) Process Improvement A3 Form V1

Evidence EP12-1, A3 Oral Care Project and Timeline

Date

Action Items Who Date Status Notes

Develop Staff Survey

Angie Frye, Amy

Freas, Laurel

Packard,

Rebekah Green,

Erika Newberg

2/22/16

Send survey to therapy staff and hospitalist staffAngie Frye or

Amy Freas?3/15/16

Present Survey questions to 7south nursing staff via email, presentation at

Shared Leadership, and staff room paper survey

Angie Frye Amy

Freas, Laurel

Packard,

Rebekah Green,

3/30/16

Hypothesized outcomes of possible interventions and created a plan for

development of a protocol and education

Angie Frye, Amy

Freas, Laurel

Packard,

Rebekah Green,

4/20/16

Develop Focused education on importance of oral care

Angie Frye,

Laurel Packard,

Rebekah Green,

Erika Newberg

5/30/16

Develop Staff reminders to document/complete oral care

Angie Frye,

Laurel Packard,

Rebekah Green,

Erika Newberg

6/30/16

Develop Oral Care Protocol

Angie Frye, Amy

FreasLaurel

Packard, , Erika

Newberg

7/30/16

Education and Protocol finalized

Angie Frye, Amy

Freas, Laurel

Packard, , Erika

Newberg,

9/28/16

Education provided to staff 10/16 and 11/16

Oral Care Protocol Implemented 11/29/16

"Meeting/Workgroup" Action Items

Evidence EP12-1, A3 Oral Care Project and Timeline