Oral Care Protocol Combined with Ventilator Bundle Reduces VAP Rates

CMS Changes in Reimbursement

Prevention of complications, including VAP, that occur in the hospital is a focus of attention for the CMS. The CMS has adopted new payment rules that go into effect in 2008 that will deny reimbursement for certain preventable complications that might occur during hospitalization, including conditions such as certain surgical site infections and pressure ulcers. These conditions were chosen because the committee determined that they are associated with high costs, are high-volume complications, and can be reasonably prevented through the use of evidence-based medical guidelines. VAP was not included in the initial set of complications listed in the new reimbursement rules because of difficulty with coding issues; however, a unique ICD-9-CM code is being developed and therefore VAP will likely be added in the 2009 CMS reimbursement rules. At that point, VAP medical costs are unlikely to be eligible for reimbursement from CMS.²⁵

Conclusion

Few studies have specifically addressed the issue of VAP and oral care in surgical patients. The results of the present project show that comprehensive oral care can dramatically reduce rates of VAP in the cardiac surgery patient population. To ensure ongoing success in reducing VAP, we instituted changes in communication and feedback with healthcare staff that ensure compliance with the oral care regimen. Our success with the three-phase perioperative oral care protocol using a prepackaged oral care system demonstrates how evidence-based oral care can improve patient outcomes.

In turn, reducing the incidence of VAP will reduce the costs of patient care, particularly in the future, when CMS begins to withhold reimbursement for VAP. The costs of care will be reduced both through reductions in direct costs and by avoiding the costs associated with denied reimbursements and increased lengths of stay. Future research should focus on whether additional patient populations would benefit from oral care intervention with this protocol and on how long to continue the protocol postoperatively.

Nancy M. Case, BSN, RN, is the clinical analyst RN for the Office of Legal and Regulatory Affairs at Cardinal Health System, Inc. in Muncie, Ind. Terri Townsend, RN, MA, CCRN, BC, CVN-II, is the educational services instructor at Ball Memorial Hospital. Renee Samples Twibell, DNS, RN, CNE, is an associate professor in the School of Nursing at Ball State University, as well as a nurse researcher at Ball Memorial Hospital. Shelia Simons, BSN, RN, works in the Cardiovascular Intensive Care Unit at Ball Memorial Hospital. Karrie Osborne, BSN, RN, works in the Cardiovascular Intensive Care Unit at Ball Memorial Hospital. Debra S. Hurst, BSN, RN, CIC, is the infection control nurse at Ball Memorial Hospital. Carolyn Sanders, MS, MT (ASCP), CIC, is the epidemiologist at Ball Memorial Hospital. Debra Siela, PhD, RN,CCNS, APRN, BC,CCRN, RRT, is a clinical nurse specialist at Ball Memorial Hospital and is an assistant professor in the School of Nursing at Ball State University.

The authors would like to thank Donna Coffman and Kersten Hammond for their medical writing and editorial assistance in the development of this manuscript. The authors have no financial interests or affiliations related to this interventional care bundle.

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