Date of Doctor of Nursing Practice Project Completion
Spring 2026
Faculty Advisor
Susan ,Alderman
Abstract
Purpose
To increase night-shift adult ICU nurse compliance with standardized oral care documentation by at least 20% as a core ventilator-associated pneumonia (VAP) prevention process.
Background
VAP is a preventable healthcare-associated infection associated with increased morbidity, mortality, ICU length of stay, and costs. Oral-care documentation is often inconsistent because of competing priorities and workflow barriers.
Methodology
Guided by the Knowledge-to-Action framework, this QI project used three PDSA cycles after a September 2025 baseline in a 16-bed ICU. Interventions included 1:1 simulation, EPIC prompts, and bedside coaching; manual audits addressed EPIC misclassification. Trends and run charts analyzed 183 records; surveys assessed knowledge/barriers (pre n=43; post n=37)
Results
Documentation adherence improved from 33% at baseline (26/79) to 48% in Cycle 1 (16/33), peaked at 64% in Cycle 2 (14/22), and remained above baseline at 55% in Cycle 3 (27/49). Correct identification of the 12-hour brushing frequency increased from 20.9% pre-intervention to 81.1% post-intervention.
Implications
This workflow-integrated approach improved documentation reliability despite high acuity and competing priorities. Sustainability requires maintaining EPIC workflow prompts, integrating expectations into onboarding and ongoing competency process, and correcting automated audit-reporting logic to reduce manual audit burden. Adoption by additional nurses and spread to other shifts is feasible with clear documentation definitions and periodic feedback.
Keywords
quality improvement, ventilator-associated pneumonia, oral care, intensive care unit, nursing compliance
Recommended Citation
Chi Hao Su, "VAP Prevention by Improving ICU Oral Care" (2026). Doctor of Nursing Practice Final Project Abstract. 147.
https://digitalcommons.library.tmc.edu/dnp_abstract/147
Consent from Advisor