Routine Nursing Screen Eradicates Pneumonia in Oncology Unit

Ingrid Hein

May 02, 2016

With a simple screening tool, nurses at a cancer treatment center were able to identify patients at high risk for hospital-acquired pneumonia and implement measures to eradicate the infection, according to a new study.

"We've done a great job. We haven't had a single pneumonia on the unit since last September," said researcher Cheryl Clements, BSN, RN, from the Cancer Treatment Centers of America at the Eastern Regional Medical Center in Philadelphia.

"The oncology patient is at higher risk for hospital-acquired pneumonia than other patients across the board," she told Medscape Medical News, but nurses needed a better way to identify those at high risk.

"It's difficult to see whether a patient has an aspiration risk when you first talk to them. They often look fine until you give them a meal or water, then you suddenly see them cough and have difficulty swallowing," she explained. "We, as nurses, wanted to see what we could do."

Clements presented the results of the study at the Oncology Nursing Society 2016 Annual Congress in San Antonio.

She and her colleagues used the Massey Bedside Swallowing Screen to test every patient on admission to the oncology telemetry unit to see if they were at high risk for aspiration, and therefore pneumonia. When a high-risk patient was identified, a strict nothing-by-mouth protocol was put in place and a speech and swallow evaluation was ordered.

"Any patients too sick to take care of their own oral hygiene were assisted by nurses," Clements explained. "Oncology patients can self-infect very easily," she added.

During the 4-month preintervention phase of the study, no screening was conducted on the unit. For the 1605 patient-days assessed, four cases of hospital-acquired pneumonia were documented.

For the intervention phase, preventive measures were used for all patients identified as high risk with the Massey Bedside Swallowing Screen. Two cases of hospital-acquired pneumonia were documented over the 4-month period, which was a 50% reduction.

Table. Incidence of Hospital-Acquired Pneumonia

Study Phase Incidence per 100 Patient-Days
No screening preintervention 2.45
Screening intervention 1.35

 

Because of the initial success of the screening, nurses continued the program and there were no cases of hospital-acquired pneumonia on the unit for another 4 months.

"We've essentially eradicated hospital-acquired pneumonia from the unit," Clements reported.

Other units at the hospital are currently implementing screening, she added. From a reimbursement perspective, the test is not difficult. "It's an easy-to-use checklist, and it's self-explanatory. We just had to make sure it was being carried out," she explained.

Awareness and reporting have really made an impact. The staff is really impressed with the results, and "nurses have actually defined this as their highest priority to discuss with other nurses at every shift and report on how many Massey bedside screenings were done," said Clements.

This screening tool is a good measure, said Amy McEachin, RN, from the Gwinnett Medical Center in Lawrenceville, Georgia.

She explained that at Gwinnett, "we don't do any screening at the moment. We ask if they've received the pneumonia vaccine on admission."

It is not always evident if a patient is sick when talking to them. "Patients don't want to be sick because they know it's going to delay their cancer treatment," she told Medscape Medical News . "We watch for a change in temperature, trouble swallowing or eating, or other changes in habit — if they're sick we can't go forward with their treatment."

It is becoming important to reduce hospital-acquired pneumonia because the Centers for Medicare and Medicaid Services is increasing measures to reduce reimbursement to hospitals under the Hospital-Acquired Condition Reduction Program, said McEachin. "There are some core measures we have to meet."

Ms Clements and Ms McEachin have disclosed no relevant financial relationships.

Oncology Nursing Society (ONS) 2016 Annual Congress. Presented April 28, 2016.

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