Title : Oral care initiative to decrease pneumonia readmission rates
Abstract:
The purpose of this project was to decrease pneumonia readmission rates. Chart audits revealed very low nursing adherence to performing and documenting patients' oral care on a medical-surgical respiratory/renal unit in a suburban 308-bed hospital in the northeast US. Readmission rates in 2025 for the hospital were over 12%. The medical-surgical respiratory/renal unit had a 15.5% readmission rate of patients returning specifically for pneumonia. Readmission rates impact patient safety, increase patient risk of adverse events, increase healthcare costs, impact hospital performance improvement plans, and in addition affect the hospital's quality rating. Documentation on oral care for this unit was 28.1%. Monthly audits were performed on oral care documentation. SBAR was created for staff education on the importance of at least twice a day oral care for all inpatient medical-surgical patients. Education with PowerPoint slides were created on how to accurately document oral care. One on one education was done for individuals that lacked documentation or struggled with charting correctly. Epic optimization was done to
add “patient performed independently” as an option. Laminated posters were placed in all patient bathrooms titled “Did you know?” This poster reinforces the importance of proper oral care performance and serves as a friendly reminder to patients and caregivers to do it! This also gave patients empowerment to ask for help with oral care and/or also ask for oral care supplies if they didn’t receive any or needed more. Almost one year after initiative the unit is now at or above threshold for 30-day readmission rates; moving from below threshold with progress seen in patients returning for pneumonia. In April 2025 the unit was at 28.1% for oral care documentation. In October 2025, 40.3% for oral care documentation to now in April 2026 to 76.9%. At first there were negative implications from staff for understanding the importance of performing oral care. Frequent audits and education on the importance of why oral care is important is continually needed. This unit has a constant flux of staff, nursing students, and a variety of service lines that interact with the patient. Sharing the importance and results with all disciplines that interact with the patient positively impacts adherence. Sustainability is key to continuing to improve pneumonia readmission rates. Future state is to possibly add virtual nurses to audit oral care documentation in real time and notify nurses' aide and nurse if oral care documentation is missing. In addition, when management rounds of patients ask the patient if they have received toothbrush, toothpaste, and mouthwash.
