Implementing Evidence based Oral Care for Critically Ill Patients

Aim: This innovative Evidence-Based Practice (EBP) implementation proposal reflects a targeted effort to achieve widespread implementation of a guideline, the American Association of Critical Care Nurses’ Practice Alert for Oral Care, by nurses in a military critical care setting. The project specifically aims to determine if an oral care program, including innovative oral care education, and implementation of an evidence-based oral care clinical guideline, results in increased knowledge, and improved oral care practice and compliance with an evidence-based oral care guideline.

Background: Evidence supports oral care as an important strategy to prevent ventilator associated pneumonia (VAP).  However, oral care is often neglected in critically ill patients or performed inadequately when patient’s mouths are swabbed only for comfort.  In addition, oral care is often not provided correctly to ventilated patients and it is not provided with the frequency that may be needed to prevent negative outcomes, such as VAP. 

Methods: The project will use a randomized, controlled, counterbalanced design to evaluate the impact of an innovative oral care program. Three outcome measures will be assessed—Knowledge measured using pre-post-tests taken by nurses (n=42; evaluated using paired t-tests), oral care practices measured using patient oral assessments (n=540 observations from 180 patients; evaluated using Chi square tests), and compliance measured by audits of inpatient electronic medical records (n=372; evaluated using RM-ANOVA). Two critical care units from one military medical center will be randomly assigned to one of two treatment groups.

Implications: By making evidence-based oral care practices a bedside habit, military nurse best practice oral care behaviors are likely to persist beyond the stateside hospital and continue when care is provided to patients in theater.