Ventilator-associated HAP has received significant
health policy and insurance company attention. As a result,
the incidence of ventilator-associated pneumonia
was significantly reduced using “bundles” of care intervention.
These bundles, used in the medical center ICUs,
include the following nursing interventions: (a) elevate
the head of the bed, (b) mobilize patients, and (c) implement
comprehensive oral care. When a patient is on the
ventilator, these interventions are expected in ICU-level
nursing care delivery systems and reliably carried out.
However, a detailed chart analysis revealed that these
same nursing care interventions were missing for many
NV-HAP patients. Of the 115 NV-HAP cases reviewed,
there was a lack of documentation of basic nursing care.
In the 24 hr prior to the onset of NV-HAP, 84% did not
receive coaching to cough and deep breathe each shift,
73% did not receive oral care each shift, 59% were not
mobilized each shift, 34% did not have the head of the