Hostname: page-component-848d4c4894-2pzkn Total loading time: 0 Render date: 2024-06-01T04:12:11.068Z Has data issue: false hasContentIssue false
  • English
  • Français

A mixed-methods evaluation of the national implementation of the Hospital-Acquired Pneumonia Prevention by Engaging Nurses (HAPPEN) initiative

Published online by Cambridge University Press:  30 August 2022

Lauren D. Stevenson Open the ORCID record for Lauren D. Stevenson [Opens in a new window] ,
Shannon Munro ,
Robert Klocko  and
George Sayre
Lauren D. Stevenson*
Affiliation:
Research and Development, Veterans’ Affairs (VA) Northeast Ohio Healthcare System, Cleveland, Ohio The VA Collaborative Evaluation Center (VACE), a virtual center based at the Rocky Mountain Regional, Seattle, and Louis Stokes Cleveland VA Medical Centers; Aurora, Colorado, Seattle, Washington, and Cleveland, Ohio
Shannon Munro
Affiliation:
Research and Development, Department of Veterans’ Affairs Medical Center, Salem, Virginia
Robert Klocko
Affiliation:
The VA Collaborative Evaluation Center (VACE), a virtual center based at the Rocky Mountain Regional, Seattle, and Louis Stokes Cleveland VA Medical Centers; Aurora, Colorado, Seattle, Washington, and Cleveland, Ohio Denver Center of Innovation for Veteran Centered and Value Driven Care (COIN), Rocky Mountain Regional VA Medical Center, Aurora, Colorado
George Sayre
Affiliation:
The VA Collaborative Evaluation Center (VACE), a virtual center based at the Rocky Mountain Regional, Seattle, and Louis Stokes Cleveland VA Medical Centers; Aurora, Colorado, Seattle, Washington, and Cleveland, Ohio Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, Washington Department of Health Services, University of Washington, Seattle, Washington
*
Author for correspondence: Lauren Stevenson, PhD, E-mail: lauren.stevenson@va.gov
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To describe healthcare provider, veteran, and organizational barriers to, challenges to, and facilitators of implementation of the oral care Hospital-Acquired Pneumonia Prevention by Engaging Nurses (HAPPEN) initiative to prevent non–ventilator-associated hospital-acquired pneumonia (NV-HAP).

Design:

Concurrent mixed methods. Qualitative interviews of staff and patients were conducted in addition to a larger survey of VA employees regarding implementation.

Setting:

Medical surgical or extended care units in 6 high-complexity (01a–c) VA hospitals.

Participants:

Between January 2020 and February 2021, we interviewed 7 staff and 7 veterans, and we received survey responses from 91 staff.

Intervention:

Provide education, support, and oral care supplies to prevent NV-HAP.

Results:

Barriers to HAPPEN implementation and tracking at the pilot sites included maintaining oral care supplies and completion of oral care documentation. Facilitators for HAPPEN implementation included development of supportive formal and informal nurse leaders, staff engagement, and shared beliefs in the importance of care quality and infection prevention. Nurses worked together as a team to provide consistent oral care. Oral care was viewed as an essential infection control practice (not just “a task”) and was considered part of the “culture” and “mission” in caring for veterans.

Conclusions:

Nurse leaders and direct-care staff were engaged throughout HAPPEN implementation, and most reported feeling supported and well prepared as they walked through the steps. Veterans reported positive experiences and increased knowledge about prevention of pneumonia. Lessons learned included building a community of practice and sharing expertise, which led to the successful replication of the HAPPEN initiative nationwide, improving patient safety and care quality and influencing health policy.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 44 , Issue 3 , March 2023 , pp. 384 - 391
Check for updates
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Munro, S, Baker, D, Giuliano, KK, et al. Nonventilator hospital-acquired pneumonia: a call to action. Infect Control Hosp Epidemiol 2021;42:991–996.CrossRefGoogle ScholarPubMed
Carey, E, Blankenhorn, R, Chen, P, Munro, S. Non–ventilator-associated hospital-acquired pneumonia incidence and health outcomes among US veterans from 2016–2020 Am J Infect Control 2022;50:116–119.CrossRefGoogle ScholarPubMed
Munro, S, Baker, D. Reducing missed oral care opportunities to prevent non–ventilator-associated hospital-acquired pneumonia at the Department of Veterans’ Affairs. Appl Nurs Res 2018;44:48–53.CrossRefGoogle ScholarPubMed
Munro, S, Haile-Mariam, A, Greenwell, C, Demirci, S, Farooqi, O, Vasudeva, S. Implementation and dissemination of a Department of Veterans’ Affairs oral care initiative to prevent hospital-acquired pneumonia among nonventilated patients. Nurs Adm Q 2018;42:363–372.CrossRefGoogle ScholarPubMed
Munro, S, Phillips, T, Hasselbeck, R, Lucatorto, MA, Hehr, A, Ochylski, S. Implementing oral care as a nursing intervention to reduce hospital-acquired pneumonia across the United States Department of Veterans’ Affairs healthcare system Comput Inform Nurs 2022;40:35–43.CrossRefGoogle Scholar
Safdar, N, Abbo, LM, Knobloch, MJ, Seo, SK. Research methods in healthcare epidemiology: survey and qualitative research. Infect Control Hosp Epidemiol 2016;37:1272–1277.CrossRefGoogle ScholarPubMed
Forman, J, Creswell, JW, Damschroder, L, Kowalski, CP, Krein, SL. Qualitative research methods: key features and insights gained from use in infection prevention research. Am J Infect Control 2008;36:764–771.CrossRefGoogle ScholarPubMed
Damschroder, LJ, Aron, DC, Keith, RE, Kirsh, SR, Alexander, JA, Lowery, JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci 2009;4:50.CrossRefGoogle Scholar
Averill, JB. Matrix analysis as a complementary analytic strategy in qualitative inquiry. Qual Health Res 2002;12:855–866.CrossRefGoogle ScholarPubMed
Hamilton, AB. 2013 CyberSeminar: Qualitative methods in rapid turn-around health services research. Health Services Research & Development website. http://www.hsrd.research.va.gov/for_researchers/cyber_seminars/archives/video_archive.cfm?SessionID=780. Accessed December 16, 2021.Google Scholar
Munro, SC, Baker, D, Giuliano, KK, et al. Nonventilator hospital-acquired pneumonia: a call to action. Infect Control Hosp Epidemiol 2021;42:991–996.CrossRefGoogle ScholarPubMed
Quick Safety Briefing Issue 61. Preventing non-ventilator hospital-acquired pneumonia. The Joint Commission website. https://www.jointcommission.org/-/media/tjc/newsletters/quick-safety-61-nvha-pneumonia-final-9-3-21.pdf. Published September 2021. Accessed January 27, 2022.Google Scholar
Weening-Verbree, LF, Schuller, DAA, Cheung, SL, Zuidema, PDSU, Schans, PDCPV, Hobbelen, DJSM. Barriers and facilitators of oral health care experienced by nursing home staff. Geriatr Nurs 2021;42:799–805.CrossRefGoogle ScholarPubMed
Saint, S, Kowalski, CP, Banaszak-Holl, J, Forman, J, Damschroder, L, Krein, SL. The importance of leadership in preventing healthcare-associated infection: results of a multisite qualitative study. Infect Control Hosp Epidemiol 2010;31:901–907.CrossRefGoogle ScholarPubMed
Stewardson, A, Pittet, D. Anatomy of a successful multimodal hand hygiene campaign. BMJ Qual Saf 2012;21:973–975.CrossRefGoogle ScholarPubMed
Talent Management System (TMS) course, “Healthy Smiles for Veterans.” Virginia Department of Health website. https://www.train.org/virginia/course/1084461/. Published February 2, 2022. Accessed April 8, 2022.Google Scholar