Date of Graduation

Fall 12-13-2024

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)

College/School

School of Nursing and Health Professions

Program

MSN project

First Advisor

Jessica Evanchak, MSN, RN, CCRN

Abstract

Objective

Oncology patients receiving chemotherapy are at risk of complications such as mucosal barrier injuries (MBI) and aspiration pneumonia, and aspiration pneumonia rates are higher than desired. Improved oral hygiene protocols and compliance in this population reduces the incidence of these complications.

Context and Background

The microsystem assessed includes six oncology units at Hospital A, a large California academic hospital. Aspiration pneumonia, commonly associated with MBI, is a life-threatening challenge that increases costs and complications in oncological treatment settings. An aspiration pneumonia task force focused on six oncology acute care units is committed to reducing the incidence of hospital acquired aspiration pneumonia.

Aim

By the end of fiscal year 2025, we will achieve a 13.3% reduction in incidences of aspiration pneumonia, from 1.5% to 1.3% of total patient discharges, among adult cancer patients in the oncology units. The goal will be accomplished through interventions focused on increasing oral hygiene compliance, nursing awareness, and more effective patient education.

Methods

Interventions were not implemented due to project time constraints. However, key drivers and proposed countermeasures were presented to nursing quality and the aspiration task force for consideration and future implementation. Suggested interventions would standardize order sets for neutropenic patients at risk for mucositis, MBI, and aspiration pneumonia, and would clarify nursing practice guidelines and expectations. They would also serve to improve patient education on oral hygiene.

There are two measures for this project. One is the outcome measure expressed in the Aim Statement of total incidences of aspiration pneumonia. The second measure is a process measure focused on oral hygiene compliance. Oral hygiene care has been shown to reduce aspiration pneumonia, making it an excellent process measure to reduce in the effort of lowering aspiration pneumonia cases. While the interventions noted above were not implemented due to project time constraints, these measures would determine the effectiveness of the interventions.

Expected Results

The following expected results are rooted evidence supported by the comprehensive literature review conducted by the quality improvement team: all chemotherapy patients will be aware and knowledgeable of the importance of oral hygiene, every patient with a paired oral hygiene order set will, at a minimum, achieve partial compliance with oral hygiene protocols, paired oral hygiene order sets will lead to increased staff and patient compliance with the oral hygiene protocols, patients will experience reduced rates of mucositis and MBI through improved compliance with oral hygiene protocols, and reduced rates of mucositis and MBI will result in reduced incidences of aspiration pneumonia.

Conclusions

Root cause analysis and patient surveys used to establish baseline metrics revealed multiple causative drivers that resulted in lower than desired oral hygiene compliance among neutropenic patients. Proposed interventions seek to increase standardization of oral hygiene order sets, clarify nursing practice guidelines and expectations, and improve patient education on oral hygiene, thus increasing oral hygiene compliance. Heightened oral hygiene compliance will decrease the incidence of aspiration pneumonia in six acute care oncology units, with the following added measures taken to sustain this quality improvement: designate and assign oral care champions in each unit, conduct patient oral care surveys biannually, and conduct monthly oral hygiene compliance reviews.

Keywords: aspiration pneumonia, oral hygiene compliance, standardized order sets

Download

Share

COinS