Implementing an evidence-based intervention to improve care for ventilator-dependent residents in a nursing home facility

Abstract

Introduction: Pneumonia is a potentially preventable cause of readmissions among nursing home residents. It was found to be a frequent cause of readmission among ventilator-dependent residents in a nursing home facility. The objective of this project was to implement and evaluate a comprehensive respiratory care program for residents dependent on ventilators and potentially decrease the readmission rate in a community nursing home. Methods: A quality improvement project was undertaken to improve the care provided to ventilator-dependent resident. Components of the project included implementation of the ventilator associated pneumonia (VAP) protocol, a hand hygiene bundle, and an education program on respiratory care. To assess the program impact, process monitoring of the elements of the VAP protocol, adherence to hand hygiene, and readmission rates were undertaken at baseline and following implementation of the program. Results: The VAP protocol was successfully implemented through education, changes to documentation, and an institutional policy. Process auditing showed improvement over time in adherence to the two elements of the protocol, elevation of head of bed and daily oral care, directly related to VAP prevention. Correct hand washing occurred 12% of the time, increasing to 68% at 6 weeks post-implementation; however, adherence decreased to 35% at the 7 months follow-up. A chart review of the reasons for readmission showed a downward trend in readmissions related to pneumonia from 29% pre-intervention to 9% following the intervention. Conclusions: This project reflects an improvement in the care provided to residents dependent on ventilators. This was accomplished by adapting the VAP protocol to fit within the nursing home context.