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At our Fremont Medical Center, Nursing Communication is the area of focus for patient experience as measured by the HCAHPS patient experience survey. The Nursing Communication composite includes Nurses Listen Carefully, Nurses Treated Me with Courtesy and Respect, and Nurses Explained Things to Me in a Way That I Can Understand.

In March 2024, Christopher Neilson, BSN, RN, NE-BC, Chief Operating Officer and Chief Nurse Executive introduced a daily “Golden Hour” from 10-11 a.m. for leader rounding, allowing leaders to connect with patients and demonstrate active listening using Commit to Sit stools in patient rooms. After rounding, the interdisciplinary leadership team holds a debrief to address care concerns and select an exceptional recognition for weekly celebration. The Magnet Care Experience team focused on improving communication tools, including adding patient education handouts to the My Hospital Visit folder. These handouts featured an updated Welcome Letter, detailing what to expect during a hospital stay, and medication information. Additional tools such as pocket amplifiers for hearing-impaired patients and ASL interpreters for deaf patients (with ASL being the sixth most prevalent language) were also implemented. As 11% of patients speak a primary language other than English, visual identification of patients needing interpreters has enhanced care team communication. These efforts contributed to meeting the Nursing Communication organizational goal for the year, with a 9 percentile increase in the benchmark score.

Left to right: Shaun Noronha, MD, Intensivist, Arveena Balu, MSN, RN, ICU Nurse Manager, Lupita Posos, BSN, RN, Arlene Acosta, BSN, RN, Grace Cacacho, BSN, RN, Roshini Sharma, Respiratory Therapist

Hospital-Acquired Pneumonia (HAP) remains one of the most common and serious infections in the ICU, contributing to prolonged hospital stays, increased health care costs and higher mortality rates. However, evidence shows that proactive strategies, including early assessment, patient mobilization and enhanced nurse education, can significantly reduce the incidence of HAP and improve patient outcomes.

Mobilization: A key strategy in HAP prevention

One of the most effective, yet often underutilized, interventions in ICU settings is early and progressive mobilization. Recent studies indicate that even short bursts of early mobilization in critically ill patients can reduce the likelihood of developing HAP. Physiologically, movement helps in preventing Ventilator-Associated Pneumonia (VAP) by enhancing airway clearance and improving overall respiratory mechanics. Importantly, early mobilization has also been shown to decrease ICU length of stay, reduce delirium and improve long-term recovery.

Sedation Assessment and Titration (SAT) and Spontaneous Breathing Trials (SBT) : A key strategy in HAP prevention

At the Fremont Medical Center ICU, reducing HAP has been a key focus, with Sedation Assessment and Titration (SAT) and Spontaneous Breathing Trials (SBT) playing a crucial role. By regularly assessing and minimizing sedation through SAT, we encourage patient alertness and improve respiratory function, which helps prevent complications like atelectasis and aspiration. Additionally, implementing SBTs allows us to evaluate a patient’s ability to breathe independently, improving lung function and reducing reliance on mechanical ventilation. Together, these strategies not only reduce the risk of HAP but also promote quicker recovery, shorter ICU stays, and better overall patient outcomes.