Oral Care Custom Clinical Practice Assessment Forms

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Clinical Practice Assessment

Comprehensive oral care can help your facility improve patient safety by reducing healthcare-associated pneumonias (HAP)—including ventilator-associated pneumonia (VAP). Before measuring progress, however, it is important to assess the current state of oral care at your facility, including current interventions and caregiver knowledge. To create your custom Clinical Practice Assessment form, start by entering the following information:

Your Name:		Click here to print a full list of questions. Click here to print a sample of a finished form.
Facility Name:
Unit:
Return Form To:

Next, check the boxes next to the questions you would like to have printed on the form. A maximum of 10 questions can be selected. When finished, click "Next Step."

I am familiar with my facility's oral care protocol.

We have a different oral care protocol for vented patients.

I know the Oral Care risk factors for developing ventilator associated pneumonia.

I have all of the components I need to provide complete oral care.

I have all of the components I need to provide complete oral care in a convenient location.

Dental plaque is not a risk factor for developing ventilator associated pneumonia.

I know the monthly incidence rate within the department for ventilator associated pneumonia.

I recognize the importance of routine oral care (cleansing, suctioning, and moisturizing) in minimizing the risk factors associated with ventilator associated pneumonia.

I know what the risk factors are for ventilator associated pneumonia.

Our unit is targeting VAP reduction.

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