Talking Magnet with ANCC SVP Rebecca Graystone

Talking Magnet with ANCC SVP Rebecca Graystone

The American Nurses Credentialing Center National Magnet and Pathway to Excellence Conference is taking place October 12-14 in Chicago, marking the largest and most influential gathering of nurses and healthcare stakeholders in the country.

If you can’t attend, we’ve got you covered in advance as we sat down with Rebecca Graystone, PhD, MBA, RN, NE-BC, and the Senior Vice President, Accreditation & Organization Credentialing of the American Nurses Credentialing Center (ANCCto discuss Magnet designation and what it means for healthcare organizations, hospitals, and nurses.

What follows is our interview, edited for length and clarity.

talking-magnet-and-nurses-with-ancc-svp-rebecca-graystone

ANCC Vice President of the Magnet Recognition Program® and Pathway to Excellence® Program, Rebecca Graystone, PhD, MBA, RN, NE-BC

-Magnet is the highest recognition of nursing excellence and signifies better staffing and working conditions for nurses, but some nurses say it’s just a costly marketing tool. What’s your response to those making that comparison?  

Magnet Recognition is steadfast proof of a hard-earned commitment to excellence in health care, with contented, valued, and inspired nurses at heart. Applicants seeking Magnet status are rigorously evaluated by expert nurse peers against evidence-based standards. Magnet is a voluntary credential earned by healthcare organizations seeking recognition for providing exceptional practice environments and patient care. 

Magnet organizations are committed to nurturing the talents of dedicated nurses throughout their careers. The work environment and organizational opportunities for staff encourage them to excel in their profession and contribute to the improved performance of their organizations, which ultimately benefits patients and the healthcare field.

Nurses working in a Magnet-recognized organization grow stronger in bedside practices, evidence-based practices and research, and leadership skills. Only around 10% of organizations in the country currently have achieved Magnet status — it’s a standard of excellence that organizations choose to commit to, and nurses will find that commitment extends to them and their success as well.    

-What does Magnet designation mean for hospitals and nurses working there? What are the benefits of working at a Magnet hospital?

For nurses and hospitals, a Magnet-recognized organization means many things. Most especially, it means the organization highly values registered nurses’ contributions to care. Across the healthcare continuum, Magnet nurses excel in leadership, professional practice, decision-making at all levels, and innovation through research and continual process improvements. The beneficiaries are patients and their families. Nurses report high satisfaction, engagement, respect, and acknowledgment for their contributions. 

Magnet organizations invest in professional education and career growth that provide an environment where nurses practice with greater autonomy in a safe and supportive environment. Research from the Journal of Nursing Administration found that nurses working in Magnet organizations have lower rates of nurse burnout and increased rates of satisfaction. 

There is a rigor and research-based element of working in a Magnet organization that attracts and produces top-tier nursing leadership and high patient satisfaction rates. For example, studies have found that Magnet organizations have decreased rates of patient falls and pressure ulcers and reduced mortality rates.  

-Approximately 10% of U.S. hospitals achieve Magnet status, and 92% of hospitals achieving Magnet status are redesignated. Talk about how a hospital benefits from becoming a Magnet hospital.

By investing in nursing education and development, Magnet hospitals attract and retain the best nurses, which has a direct and positive effect on the standard of care and improved patient experience.  

Magnet hospitals consistently provide the highest quality of care. Studies find that Magnet-recognized organizations experience increased patient satisfaction, decreased mortality rates, decreased falls, and improved patient safety and quality.

Magnet recognition also contributes to the stability and growth of hospitals in various ways, such as reducing RN agency rates, decreasing RN vacancy rates and turnover, and reducing staff injuries. There are positive financial impacts as well. When an organization is recognized as Magnet, they have an increased chance to establish endowments, enjoy a stronger bond rating, and have a competitive advantage in regional markets.  

-Why wouldn’t a hospital maintain Magnet status? 

Magnet recognition lasts for four years.  Interestingly, we have seen our retention rate rise in recent years (from 90% on average to 92.1% in the last three years), and this was during the pandemic. So, this seems to indicate that organizations are using the Magnet culture and standards as their North Star, which helped to guide them and sustain them through the height of COVID-19.

-What happens if a hospital loses Magnet status?

Again, participation in Magnet is voluntary. Magnet organizations report anecdotally their desire to retain Magnet status. When this is not possible, reasons given include a change in leadership has shifted priorities, and the resources to support the infrastructure of excellence Magnet requires are redistributed toward other efforts. Most hospitals want to maintain Magnet status because it signals their commitment to nursing excellence. 

-Talk about how the Magnet Recognition program spreads internationally and the top countries seeking accreditation. 

Magnet Recognition is a rigorous credential and organization-based, peer-reviewed appraisal process. All standards are evidence-based and achievable no matter the size of the organization or location in the world. What Magnet Recognition achievement represents is a commitment by the organization to a culture of nursing excellence.

We currently have 612 Magnet facilities in total. The majority are in the U.S., but we have facilities in Australia, Saudi Arabia, Belgium, Japan, Jordan, Lebanon, the United Kingdom, the United Arab Emirates, Canada, and Brazil. There is a keen interest in Magnet internationally, and we have seen this through our increase in Magnet applications and conference registrations from across the globe for our ANCC National Magnet Conference® and Pathway to Excellence Conference.® There is a desire to learn from the best of the best and bring that knowledge home with them and share it.

We’ll be at the 2023 ANCC National Magnet Conference® October 12-14 at the at the McCormick Place Convention Center in Chicago, Illinois. Stop by booth #918. We look forward to seeing you there!

Exploring the Magnet Metaphor 

Exploring the Magnet Metaphor 

As we mark the annual celebration and recognition of all that the Magnet model represents in healthcare here in the U.S. and around the world, it’s timely to pause to consider just what magnetism is and what makes this metaphor so apt in our 21st-century world.

The Science of Magnetism

Children are easily fascinated when playing with magnets. The developing brain of a child enthusiastically and curiously examines how different metals repel and attract one another, and no matter how magical it may seem, the forces in question are deeply based on science and physics.

Very simply put, electrons, neutrons, and other subatomic particles each carry either a positive or negative electrical charge, and their constant motion contributes to the creation of magnetic fields.

While the actual scientific force of magnetism cannot be held responsible for nurses being drawn to work at healthcare facilities holding the Magnet designation (just as Albert Einstein observed that gravity cannot be held responsible for people falling in love), there is undoubtedly a type of gravitational pull that causes certain nurses to prioritize working at Magnet facilities.

The science of magnetism is a known fact among physicists, scientists, and laypeople who can be bothered to understand how such a phenomenon works. Yet, the metaphor of magnetism in relation to hospitals and healthcare workplaces is another kind of phenomenon entirely.

The Power of Magnetism

If the physical force of magnetism is caused by the movement of positively or negatively charged subatomic particles, then it must figure that there are aspects of the Magnet model that serve as charged particles within a healthcare workplace that attracts talented and forward-looking nurses.

To explore our metaphor further, we can examine the Commission on Magnet’s new vision , which is meant to communicate the aspects of Magnet organizations that are seen as holding the most potential for changing patient outcomes and the face of healthcare in profound ways.

The Commission’s vision includes:

  • The forces of transformational leadership
  • Structural empowerment
  • Exemplary professional practice
  • New knowledge, innovation, and improvement.
  • Empirical quality result.

Let’s briefly examine each.

Transformational leadership: This model component wants leaders “no longer just to solve problems, fix broken systems, and empower staff, but to actually transform the organizations to meet the future.”

Most nurses want to be led by visionary leaders who have everyone’s best interests in mind, not to mention leaders who can create new approaches to processes that are broken or past their prime. It’s been said many times that employees most often quit jobs and leave organizations because of leadership issues. Thus, nurse retention (organizational magnetism) must begin with inspired leadership.

Structural empowerment: This component provides “an innovative environment where strong professional practice flourishes and where the mission, vision, and values come to life to achieve the outcomes believed to be important for the organization.” Strategic plans, policies, and other aspects of the organization must magnetize and empower nurses and other staff to achieve their best.

Exemplary professional practice: Most nurses want this for themselves, focusing on evidence-based practice, high-level communication skills, multidisciplinary collaboration, and ongoing development of skills and knowledge. Magnetic indeed.

New knowledge, innovation, and improvements: The Commission states, “Our current systems and practices need to be redesigned and redefined if we are to be successful in the future. This Component includes new models of care, application of existing evidence, new evidence, and visible contributions to the science of nursing.” We all know that nursing and healthcare cannot stand still and rest on yesterday’s accomplishments and knowledge. If we are not moving forward, stagnation results and our patients and communities deserve much more. We must magnetize forward movement and forward thinking.

Empirical quality results: Quantitative and qualitative measures are essential when assessing outcomes, and since nursing is a science-based discipline, empirical evidence is crucial. Measuring and sharing the outcomes of our actions is a path to recording and categorizing our accomplishments and assessing the practices that got us there.

These and other aspects of the Magnet model serve as metaphorical forces of magnetism that draw certain nurses to organizations that practice in such a manner. These charged particles of practice, innovation, and empowerment will attract nurses interested in practicing at the top of their license while working for institutions that value innovation, creative thinking, and exemplary professionalism.

Magnifying the Good

The Magnet model is an example of a positively charged force that draws to it those naturally attracted to that force. The pillars of the Magnet model serve as particles that draw to them nurses of like mind, like a magnet that causes certain substances to cling to it.

Substandard workplaces that undervalue nurses and treat them like cannon fodder repel nurses, pushing them away when they can no longer tolerate a workplace opposite of what the Magnet model represents. Some healthcare workplaces need to do more to ensure they achieve the best possible patient outcomes with happy, satisfied, and highly valued staff. These institutions shoot for the lowest common denominator; the results speak for themselves.

Let’s focus on magnetizing and empowering that which makes nursing and healthcare shine. And for those drawn to the Magnet model, there’s much to learn along this growth, innovation, and positivity continuum.

Are you looking for your next career opportunity at a Magnet hospital? Check out our Magnet showcase. Then, your next job can be waiting for you!

We’ll be at the 2023 ANCC National Magnet Conference® October 12-14 at the at the McCormick Place Convention Center in Chicago, Illinois. Stop by booth #918. We look forward to seeing you there!

National Assessment Highlights COVID-19 Impact on ED Pediatric Capabilities

National Assessment Highlights COVID-19 Impact on ED Pediatric Capabilities

Emergency departments (EDs) have made progress but still need to fully meet national guidelines for pediatric emergency care, despite the association with improved survival, found a study in JAMA Network Open.

The findings are based on a 2021 reassessment of EDs by the National Pediatric Readiness Project , a partnership of the Emergency Nurses Association, the American Academy of Pediatrics, and the American College of Emergency Physicians, led by the Emergency Medical Services for Children Program, part of the federal Health Resources and Services Administration.

“To treat children accurately in the ED takes not only specialized equipment but appropriate knowledge and policies,” says ENA President Terry Foster, MSN, RN, CEN, CPEN, CCRN, TCRN, FAEN. “It’s imperative that everyone in the ED is committed to improving pediatric care, especially with the ongoing pediatric mental health crisis and boarding issues.”

The assessment evaluates EDs on a 100-point scale. In 2021, 5,150 EDs were surveyed, with 3,647 responding and 3,557 available for full analysis. The median score was 69.5, which increased with annual pediatric patient volume.

The results largely indicate the progress from the last assessment in 2013, which was based on earlier guidelines.

“Comparing commonalities between the two assessments, we see improvement in five of six categories,” says Kate Remick, MD, the study’s lead author and co-director of the NPRP. “This is especially positive given EDs were navigating the pandemic at the time of the survey.”

But researchers say COVID-19 did contribute to a decline in one pivotal category: designating a nurse and physician – ideally both – as pediatric emergency care coordinators. EDs reporting physician and nurse PECCs decreased to 28.5% in 2021, a 13.5% drop.

“PECCs are a key driver of pediatric readiness,” says Hilary Hewes, MD, study co-author. “Unfortunately, the pandemic worsened widespread workforce shortages. Many EDs didn’t have resources to sustain the PECC role.”

As a result of the decline in this heavily weighted category, when comparing common data points, researchers say there was a slight decrease – 1.6 points – in adjusted median scores.

“The decrease is minor given the unique circumstances of COVID-19,” notes Marianne Gausche-Hill, MD, study co-author and NPRP co-director, who is considered a pioneer in pediatric readiness work. “The improvement in five of six categories despite these circumstances is most notable, reflecting high engagement of providers over the last eight years.”

Still, researchers point out the median falls below 88, the minimum score associated with marked improvements in survival. A 2019 study tied higher pediatric readiness to four-fold lower mortality in critically ill children.

To improve readiness, researchers emphasize the importance of designating PECCs. Implementing pediatric-specific quality improvement plans and staffing with board-certified emergency medicine physicians are also associated with score increases.

“We hope all EDs, regardless of volume, will prioritize these three components of pediatric readiness,” says Gausche-Hill. “The association of pediatric readiness with improved survival makes it a health care imperative.”

Checklist Prompters Support ICU Rounds

Checklist Prompters Support ICU Rounds

Rounding checklists can help hospital care teams improve patient outcomes. New research points to the potential for patient-specific checklists as a valid way to effectively translate the latest evidence into clinical practice.

These checklists can be helpful tools during daily rounds when multidisciplinary patient care team members convene to discuss each patient’s status and care plan. However, if too complex or generic, the checklists may instead become a burden, taking up valuable time with minimal impact.

One way to customize rounding checklists is to have an individual serve as a checklist prompter, listen to the conversation, eliminate items as they are addressed, and remind the team to consider any remaining elements that should be discussed. These customized approaches assume that a prompter is reliable for confirming whether each checklist element is addressed

Measuring Performance on the ABCDEF Bundle During Interprofessional Rounds via a Nurse-Based Assessment Tool ” found that a single trained observer serving as a checklist prompter can reliably assess whether rounding discussions among the multidisciplinary patient care team addressed elements of the ABCDEF bundle. The evidence-based bundle includes various elements related to pain, agitation, delirium, ventilator care, and family engagement. 

Researchers from the University of Pittsburgh, Pennsylvania, and other institutions conducted the study at two intensive care units (ICUs) at UPMC, a tertiary care medical center that is an academic affiliate of the university.

The team developed a paper-based assessment tool with a series of Yes/No items related to the ABCDEF bundle, allowing a nurse observer to circle whether an element had been addressed during rounds

Two nurses performed in-person observations of multidisciplinary morning rounds on 15 observation days in the fall of 2021. Most rounding discussions occurred in the hallway rather than the patient rooms due to institutional norms and COVID-19. The observers listened independently only to the rounding team’s discussions, without looking at the patient’s electronic health record or looking for visual cues from the patient’s room

In total, 53 different patients were observed, with 33 of them receiving invasive mechanical ventilation. Because ICU admissions often last multiple days, discussions often address the same patient over different days. The nurse observers documented 118 patient discussions, and their dually observed discussions are the basis for calculating reliability and agreement.

“Checklists are frequently used as a strategy for increasing adoption of the ABCDEF bundle, and our research has several important implications for performance improvement and quality measurement in the ICU,” says lead author Andrew J. King, PhD, research assistant professor of critical care medicine at the University of Pittsburgh School of Medicine.

The results indicate that nurses can identify when a rounding checklist element has been addressed and, therefore, might not need to be repeated during a readout of the checklist. This added flexibility enables a shorter, patient-specific checklist, which could streamline workflows.

In addition to empowering clinicians to customize checklists for each patient, the study shows that critical care nurses are ideal candidates to be independent checklist prompters during rounds.

The researchers also conclude that the assessment tool created for the study could serve as the basis for occasional strategic measurement of team performance, especially during emergency response, shift handoffs, and other times when team communication is essential.

Mount Sinai South Nassau Receives $5 Million Donation

Mount Sinai South Nassau Receives $5 Million Donation

Mount Sinai South Nassau has received the largest single gift in the hospital’s history – a $5 million pledge from The Louis Feil Charitable Lead Annuity Trust to name the hospital’s new patient care pavilion. 

The new four-story, 100,000-square-foot building, scheduled to open in spring 2024, will be named the Feil Family Pavilion. It will double the size of the current Emergency Department, increase the critical and intensive care inpatient capacity to 40 beds, and add nine new operating rooms.

Mount Sinai South Nassau is our local hospital, and we are grateful for the expert care it provides to our communities on the South Shore,” says Jeffrey J. Feil, CEO of the Feil Organization and a longtime Rockville Centre resident. “We are so fortunate to have an outstanding medical center right in our backyard. The Feil family is honored to support the growth of Mount Sinai South Nassau.”

Mr. Feil and his family, including his parents, the late Gertrude and Louis, have been longtime supporters of the hospital. With their latest gift, the family has donated $17 million to benefit the hospital and the patients it serves.

“This generous gift by the Feil family will have a direct impact on improving patient care on the South Shore. We are deeply thankful for their generosity and support,” says Adhi Sharma, MD, President of Mount Sinai South Nassau. “It will be the hospital’s distinct honor to name the new patient care tower in honor and recognition of the Feil Family and their longstanding commitment to Mount Sinai South Nassau.”

“Their support and commitment have been vital to the growth of our emergency services and cancer care program as well as the hospital’s tradition of excellence in the delivery of advanced care services,” Dr. Sharma adds.

“The ultimate beneficiary of the Feil family’s generosity is our South Shore community that turns to Mount Sinai South Nassau for compassionate, quality health care,” says Tony Cancellieri, Co-Chair of Mount Sinai South Nassau’s Board of Directors. “On behalf of the Hospital’s Board of Directors, we are grateful to our dear friends Jeffrey and Lee Feil and their entire family and are honored to name the pavilion as a permanent expression of gratitude for this gift and the ongoing support of the Feil family.”

The donation is the single largest gift the hospital has ever received. The family’s previous generosity includes a total of $2 million in 2019 and $1.5 million in 2018 to help centralize the hospital’s cancer care services and a $3 million donation to Mount Sinai South Nassau in the spring of 2011 that supported the continued growth and expansion of the Gertrude & Louis Feil Cancer Center.

The Feil gift is the second significant gift connected with the new four-story patient building currently under construction. Last year, the hospital’s immediate past Chair of the Board, Joseph Fennessy, made a major gift to the hospital to name the pedestrian entrance to the new Emergency Department after the Fennessy family. Additional naming opportunities remain within the new pavilion, including nursing stations, lobby areas, and surgical suites. 

Mount Sinai South Nassau’s Emergency Department treats about 65,000 patients annually but is designed to handle only 35,000. Upon completion of the Feil Family Pavilion, the Emergency Department’s square footage will nearly double the size of a football field. It will have the capacity to see approximately 80,000 patients annually. In addition, the department will feature centralized nursing stations for direct oversight of patient rooms; bedside triage; expanded pediatric trauma treatment areas with an adjoining radiology area; a decontamination room; dedicated areas for geriatrics and behavioral health; and a spacious waiting and reception area with comfortable seating, 4K-UHD TVs, free Wi-Fi, and charging stations for phones, tablets, and laptops.

The pavilion’s expanded intensive (ICU) and critical care (CCU) units will allow Mount Sinai South Nassau to meet the region’s rising need for critical care services, as demonstrated during the COVID-19 pandemic. While the demand for regular hospital beds is decreasing, the number of patients needing highly specialized care provided in ICUs and CCUs is rising. The hospital projects that the need for ICU and CCU beds will double.

The operating room and its surgical suites will be configured and designed to accommodate nonstop advancements in surgical technologies and equipment. The combined impact of the redesigned and larger operating rooms will allow Mount Sinai South Nassau and its staff of surgeons to increase its surgical scheduling capacity to accommodate projected volumes in same-day, elective, and emergency surgeries. The new surgical suites also could pave the way for an open-heart program at the Oceanside campus, pending Department of Health approval.

Hospital-Acquired Pneumonia (NVHAP) Is Killing Patients. Yet There Is a Simple Solution.

Hospital-Acquired Pneumonia (NVHAP) Is Killing Patients. Yet There Is a Simple Solution.

Four years ago, when Karen Giuliano, Ph.D., MSN, MBA, FAAN went to a Boston hospital for hip replacement surgery, she was given a pale-pink bucket of toiletries issued to patients in many hospitals. Inside were tissues, bar soap, deodorant, toothpaste, and, without a doubt, the worst toothbrush she’d ever seen.

“I couldn’t believe it. I got a toothbrush with no bristles,” she said. “It must have not gone through the bristle machine. It was just a stick.” Karen Giuliano, Ph.D., MSN, MBA, FAAN.

To most patients, a useless hospital toothbrush would be a mild inconvenience. But to Giuliano, a nursing professor at the University of Massachusetts Amherst , it was a reminder of a pervasive “blind spot” in U.S. hospitals: the stunning consequences of unbrushed teeth.

Hospital patients not getting their teeth brushed, or not brushing their teeth themselves, is believed to be a leading cause of hundreds of thousands of cases of pneumonia a year in patients who have not been put on a ventilator. Pneumonia is among the most common infections that occur in health care facilities, and a majority of cases are non-ventilator hospital-acquired pneumonia, or NVHAP, which kills up to 30% of those infected, Giuliano and other experts said.

But unlike many infections that strike within hospitals, the federal government doesn’t require hospitals to report cases of NVHAP. As a result, few hospitals understand the origin of the illness, track its occurrence, or actively work to prevent it, the experts said.

When nurses help patients brush their teeth, it’s not just to give them “kissing fresh breath”

Many cases of NVHAP could be avoided if hospital staffers more dutifully brushed the teeth of bedridden patients, according to a growing body of peer-reviewed research papers. Instead, many hospitals often skip teeth brushing to prioritize other tasks and provide only cheap, ineffective toothbrushes, often unaware of the consequences, said Dian Baker, a Sacramento State nursing professor who has spent more than a decade studying NVHAP.

“I’ll tell you that today the vast majority of the tens of thousands of nurses in hospitals have no idea that pneumonia comes from germs in the mouth,” Baker said.

NVHAP is often caused by bacteria from the mouth that gathers on unbrushed teeth and is aspirated into the lungs. Patients face a higher risk if they lie flat or remain immobile for long periods, so NVHAP can also be prevented by elevating their heads and getting them out of bed more often.

Pneumonia occurs when germs trigger an infection in the lungs. Although NVHAP accounts for most of the cases that occur in hospitals, it historically has not received the same attention as pneumonia tied to ventilators, which is easier to identify and study because it occurs among a narrow subset of patients.

NVHAP, a risk for virtually all hospital patients, is often caused by bacteria from the mouth that gathers in the scummy biofilm on unbrushed teeth and is aspirated into the lungs. Patients face a higher risk if they lie flat or remain immobile for long periods, so NVHAP can also be prevented by elevating their heads and getting them out of bed more often. Originally published in Kaiser Health News.

According to the National Organization for NV-HAP Prevention, which was founded in 2020, this pneumonia infects about 1 in every 100 hospital patients and kills 15% to 30% of them. For those who survive, the illness often extends their hospital stay by up to 15 days and makes it much more likely they will be readmitted within a month or transferred to an intensive care unit.

John McCleary, 83, of Millinocket, Maine, contracted a likely case of NVHAP in 2008 after he fractured his ankle in a fall and spent 12 days in rehabilitation at a hospital, said his daughter, Kathy Day, a retired nurse and advocate with the Patient Safety Action Network.

McCleary recovered from the fracture but not from pneumonia. Two days after he returned home, the infection in his lungs caused him to be rushed back to the hospital, where he went into sepsis and spent weeks in treatment before moving to an isolation unit in a nursing home.

He died weeks later, emaciated, largely deaf, unable to eat, and often “too weak to get water through a straw,” his daughter said. After contracting pneumonia, he never walked again.

“It was an astounding assault on his body, from him being here visiting me the week before his fall, to his death just a few months later,” Day said. “And the whole thing was avoidable.”

“Could this be the tip of the iceberg? … Probably.”

While experts describe NVHAP as a largely ignored threat, that appears to be changing.

Last year, a group of researchers — including Giuliano and Baker, plus officials from the Centers for Disease Control and Prevention, the Veterans Health Administration, and the Joint Commission — published a “call-to-action” research paper hoping to launch “a national healthcare conversation about NVHAP prevention.”

The Joint Commission, a nonprofit organization whose accreditation can make or break hospitals, is considering broadening the infection control standards to include more ailments, including NVHAP, said Sylvia Garcia-Houchins, its director of infection prevention and control.

Separately, ECRI, a nonprofit focused on health care safety, this year pinpointed NVHAP as one of its top patient safety concerns.

James Davis, an ECRI infection expert, said the prevalence of NVHAP, while already alarming, is likely “underestimated” and probably worsened as hospitals swelled with patients during the coronavirus pandemic.

“We only know what’s reported,” Davis said. “Could this be the tip of the iceberg? I would say, in my opinion, probably.”

To better measure the condition, some researchers call for a standardized surveillance definition of NVHAP, which could in time open the door for the federal government to mandate reporting of cases or incentivize prevention. With increasing urgency, researchers are pushing for hospitals not to wait for the federal government to act against NVHAP.

Baker said she has spoken with hundreds of hospitals about how to prevent NVHAP, but thousands more have yet to take up the cause.

“We are not asking for some big, $300,000 piece of equipment,” Baker said. “The two things that show the best evidence of preventing this harm are things that should be happening in standard care anyway ― brushing teeth and getting patients mobilized.”

We know that brushing teeth + more mobility lowers infection rates

That evidence comes from a smattering of studies that show those two strategies can lead to sharp reductions in infection rates.

In California, a study at 21 Kaiser Permanente hospitals used a reprioritization of oral care and getting patients out of bed to reduce rates of hospital-acquired pneumonia by around 70%. At Sutter Medical Center in Sacramento, better oral care reduced NVHAP cases by a yearly average of 35%.

At Orlando Regional Medical Center in Florida, a medical unit and a surgical unit where patients received enhanced oral care reduced NVHAP rates by 85% and 56%, respectively, when compared with similar units that received normal care. A similar study is underway at two hospitals in Illinois.

And the most compelling results come from a veterans’ hospital in Salem, Virginia, where a 2016 oral care pilot program reduced rates of NVHAP by 92% — saving an estimated 13 lives in just 19 months. The program, the HAPPEN Initiative, has been expanded across the Veterans Health Administration, and experts say it could serve as a model for all U.S. hospitals.

Michelle Lucatorto, a nursing official who leads HAPPEN, said the program trains nurses to most effectively brush patients’ teeth and educates patients and families on the link between oral care and preventing NVHAP. While teeth brushing may not seem to require training, Lucatorto made comparisons to how the coronavirus revealed many Americans were doing a lackluster job of another routine hygienic practice: washing their hands.

“Sometimes we are searching for the most complicated intervention,” she said. “We are always looking for that new bypass surgery or some new technical equipment. And sometimes I think we fail to look at the simple things we can do in our practice to save people’s lives.”

 

  • KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.