Operationalizing and monitoring a nurse-led 3-KPI bundle for aspiration-risk care in dementia long-term care: A 4-week unit-level quality-improvement measurement pilot.

BACKGROUND: Aspiration risk is common in dementia long-term care, yet bedside nursing processes intended to address that risk are often inconsistently defined and difficult to audit at the unit level. METHODS: We conducted a 4-week unit-level quality-improvement measurement pilot in a 24-bed memory-care unit by operationalizing and monitoring three pre-specified nursing process KPIs: postprandial upright positioning for ≥45 min, red-flag escalation within ≤30 min, and oral care ≥2 times per 24 h. Operational supports included brief staff training, pocket prompts, bedside checklists, and shift huddles. Weekly run charts summarized documented KPI percentages. Hydration <1500 mL/day and ≥5% monthly weight loss were monitored as balancing measures. RESULTS: Across the 4-week monitoring period, documented KPI percentages increased at the unit level. Postprandial upright positioning rose from 42% to 91%, timely red-flag escalation from 58% to 93%, and oral care ≥2 times per 24 h from 41% to 73%, with a temporary Week 4 dip after a Week 3 peak that was linked to weekend staffing, supply, and handoff barriers. Hydration <1500 mL/day declined from 18% to 12%; one weight-loss event was recorded in Week 4. CONCLUSIONS: In this single-unit, short-duration quality-improvement measurement pilot, a nurse-led 3-KPI bundle was operationalized and monitored during routine care. The findings support local learning about how aspiration-risk care processes can be specified, documented, audited, and refined in dementia long-term care, but they should not be interpreted as evidence of causal effectiveness, improved care delivery, or reduced aspiration-related clinical events.