Assisting Veterans with oral care during hospital stays to prevent pneumonia

Preventing pneumonia during a Veteran's hospital stay could be as simple as improving their oral health. Non-Ventilator Associated Hospital Acquired Pneumonia (NV-HAP) is one of the most common infections in hospitals and accounts for 60% of hospital acquired pneumonia cases nationwide.

Hospitalized Veterans who develop NV-HAP face a higher risk of mortality, longer hospital stays and complications like sepsis compared to Veterans who do not develop NV-HAP.

Since all Veterans in VA hospitals and long-term care settings are at risk for NV-HAP, prevention measures like consistent oral care are essential.

A proactive approach to oral care regimens

Hospital Acquired Pneumonia Prevention by Engaging Nurses (HAPPEN) is a program that supports the prevention of NV-HAP. A team of nurses at the Salem VA Medical Center launched HAPPEN after recognizing the need for oral care services to prevent the development of pneumonia among non-ventilated Veterans.

The nurse-led program, supported by a multidisciplinary team including dental professionals, reduces NV-HAP cases by offering education and assistance with completing oral care in hospitals and long-term care settings. The HAPPEN model empowers nurses to provide consistent, effective oral care at least twice daily for Veterans during their hospital or long-term care stay.

VA facilities monitor oral care documentation and NV-HAP rates to provide continuous high-quality care. Veterans on units implementing HAPPEN report high satisfaction with the initiative and gain a better understanding of the importance of oral care in preventing NV-HAP. Each NV-HAP case prevented is predicted to save over $100,000 in 12-month health care costs.

"HAPPEN demonstrates the power of VA's engaged frontline nursing workforce to identify an opportunity, develop an evidence-based solution and scale that innovation across the nation," said Dr. Sheila Cox-Sullivan, director of Research Evidence Based Practices and Analytics in VA's Office of Nursing Services.

Scaling successes and future direction

Within HAPPEN's first year, the rate of NV-HAP decreased 92% among Veterans residing in Salem VA's long term care units. In 2015, HAPPEN entered VHA Shark Tank competition, earning a winning bid to replicate the program at Houston VA.

With support from VHA's Diffusion of Excellence program and VHA's Office of Rural Health, HAPPEN began expanding nationwide and, by July 2021, HAPPEN's innovative approach to NV-HAP prevention had expanded to all VA medical centers. VA medical centers that implemented HAPPEN reported an average 40-60% decrease in NV-HAP cases, reducing the average length of hospital stays and need for long-term care for Veterans.

In September 2024, the American Academy of Nursing selected HAPPEN as one of six Academy Edge Runners, an honor awarded to the practice for reducing the risk of NV-HAP among Veterans, shortening hospital stay and saving lives.

Learn more

To learn more about HAPPEN, visit the HAPPEN page on Diffusion Marketplace and read more about the practice's recent designation as an Academy Edge Runner.

Want to learn more about innovation at VA? View the 2024 VHA State of Innovation report, visit our website, subscribe to our weekly newsletter and explore VA Pathfinder to learn more about our opportunities.

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