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 undergoing chemotherapy are at increased risk of mucosal barrier injuries and aspiration pneumonia, with current aspiration pneumonia rates exceeding target levels. Enhanced oral hygiene protocols and improved compliance have been shown to reduce these complications in this vulnerable population.

Context: The microsystem under review comprises six oncology units within Hospital A, a major medical center in California. Aspiration pneumonia, frequently linked to mucosal barrier injuries, poses a significant threat to patient safety and increases treatment costs and complications in oncology care. Recognizing the critical need to address this issue, an aspiration pneumonia task force has prioritized efforts to reduce nosocomial aspiration pneumonia rates across the oncology units.

Aim: By the end of fiscal year 2025, the project aims to reduce the incidence of aspiration pneumonia among adult oncology patients from 1.5% to 1.3% of total discharges—a 13.3% reduction. This goal will be achieved through targeted interventions to improve oral hygiene compliance, increase nursing awareness, and enhance patient education.

Methods: Due to project time constraints, interventions were not implemented; however, proposed strategies were presented to nursing quality leaders and the aspiration task force for future consideration. Recommended actions include standardizing oral hygiene order sets for neutropenic patients at risk for mucositis, mucosal barrier injuries, and aspiration pneumonia, clarifying nursing guidelines, and improving patient education. Two key measures were identified: an outcome measure tracking aspiration pneumonia rates and a process measure assessing oral hygiene compliance, both critical to evaluating intervention success.

Expected Results: Evidence from the literature supports the anticipated outcomes: increased patient awareness about oral hygiene, higher compliance with oral hygiene protocols for patients with paired order sets, and improved nursing adherence to standardized practices. Enhanced compliance is expected to lower rates of mucositis and mucosal barrier injuries, which, in turn, will reduce the incidence of aspiration pneumonia.

Conclusion: Root cause analysis and baseline data identified key drivers contributing to low oral hygiene compliance among neutropenic patients. Proposed interventions aim to standardize oral hygiene practices, refine nursing guidelines, and strengthen patient education, ultimately improving compliance and reducing aspiration pneumonia rates across six acute care oncology units. Sustainability measures include appointing oral care champions, conducting biannual patient questionnaires, and implementing monthly compliance audits.

Keywords: aspiration pneumonia, mucosal barrier injuries, mucositis, oral hygiene compliance, oral saline rinses, oncology department, education, standardized oral hygiene order sets

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