Operational Excellence

Document Type


Publication Date

Summer 7-11-2019

MeSH Headings

nursing home, health care system, pneumonias, oral health, goal root cause analysis, owns, patient care


Oral care is an essential part of preventative medicine as it minimizes risk for pneumonias and other infections. In nursing home settings, often oral health care is not routinely provided due to a number of issues. A health care system that either owns or contracts nursing home facilities initiated a performance improvement plan to address this patient care concern.

The first goal of this project was to reduce the variation in oral care between nursing home facilities within the system. The second goal was 100% of their patients will have one oral health care exam documented in EPIC once a year.

Baseline metrics bore out the low number of oral exams routinely performed and a root cause analysis examined the various reasons why nursing home patients do not receive oral care during routine care.

A number of countermeasures were implemented to include the creation of a flowsheet for oral exams, automated EPIC reminders to conduct oral exams and a monthly report on oral care exams distributed to providers by the nursing home director.

As a result of the interventions, the baseline of 6% in July 2018 was up to 70% in May 2019. It is expected that the goal of 100% will be met by October 2019. In addition, assessment variation between facilities saw a reduction. Some of the next steps include integration of a second oral healthcare assessment per year as a practice standard and continue to assess and reduce variations in assessments between facilities.