Date of Degree
Fall 2025
Document Type
DNP Scholarly Project
Academic Department
School of Nursing
Degree Type
Doctoral
Degree Name
Doctor of Nursing Practice
First Advisor
Dr. Melanie Brewer
Abstract
Problem: Oral care is essential for reducing bacteria and preventing aspiration pneumonia. The risk of aspiration pneumonia increases when protocols are not followed. In 2024, a regional hospital in the Midwest United States spent approximately one million dollars on the preventable healthcare-associated infection known as aspiration pneumonia. A pre-project chart audit of 100 random patient charts on a medical/surgical step-down unit revealed that only 1 of the 100 charts had oral care documented as completed.
Aim of the Project: The primary aims of this project were to increase nursing documentation of oral care by 50% and to decrease aspiration pneumonia cases by 10%.
Review of the Evidence: Evidence suggests that oral care completed at least twice daily is an effective strategy for reducing bacteria in the mouth. Riding the mouth of stationary bacteria prevents the bacteria from spreading and potentially being aspirated into the lungs, causing aspiration pneumonia.
Project Design: The Ohio Health Change Management Model (OHCMM), a three-cycle Plan Do Study Act (PDSA) framework from the Institute for Healthcare Improvement, and the United States Department of Veterans Affairs Oral Care Toolkit initiative were used to implement the QI project.
Intervention: Nursing staff on a medical/surgical step-down unit were instructed to complete and document oral care twice daily for each patient admitted, in accordance with evidence-based recommendations. The nursing interventions included targeted education, weekly chart audits to monitor compliance, twice-daily reminders about the project expectations, and announcements of weekly chart audit compliance during nursing huddle reports, face-to-face project leadership rounding, and two presentations to the Nursing Shared Governance.
Significant Findings/Outcomes: A 26% increase in documentation compliance indicated the success of the interventions compared to a baseline compliance rate of 1%. A total of 11 aspiration pneumonia cases were diagnosed during the project, revealing a 39% decrease compared to the baseline data of 18 aspiration pneumonia cases. The interventions resulted in an estimated cost avoidance of $70,210.
Implications for Nursing: The QI initiative emphasized the importance of completing oral care twice daily for each patient. Recurring reminders of the protocol recommendations foster accountability and repetition, enhancing staff confidence through repeated practice, which ultimately leads to the sustained delivery of high-quality care.
Recommended Citation
London, Jennifer, "Reducing Aspiration Pneumonia by Implementing an Enhanced Oral Care Toolkit" (2025). Doctor of Nursing Practice (DNP) Scholarly Project. 49.
https://fuse.franklin.edu/dnp-project/49
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