2.50
Hdl Handle:
http://hdl.handle.net/10755/162661
Type:
Presentation
Title:
Early Identification and Treatment of Community Acquired Pneumonia
Abstract:
Early Identification and Treatment of Community Acquired Pneumonia
Conference Sponsor:Emergency Nurses Association
Conference Year:2007
Author:Kostel-Donlon, Nancy, RN, BC, MSN, CEN, CCRN, CPAN
P.I. Institution Name:St. Francis Hospital ? The Heart Center
Title:Clinical Nurse specialist
Contact Address:100 Port Washington Blvd., Roslyn, NY, 11576, USA
Contact Telephone:(516) 562-6000, ext. 5012
[Clinical Poster] Clinical Topic: Community-acquired pneumonia, which afflicts millions of people annually, is defined as clinical evidence of pneumonia that occurs in individuals who are residing in the community and who have not been hospitalized in the past seven days. The Joint Commission on the Accreditation of Health Care Organizations (JCAHO) and the Centers for Medicare & Medicaid Services (CMS) have published data that ranks organizations according to their compliance with the core measures of community acquired pneumonia that include: oxygen assessment, timeliness of blood cultures and antibiotics, antibiotic selection, influenza and pneumonia vaccination, and smoking cessation counseling. Recently, an [Clinical Poster] Clinical Topic: Academic emergency departments (EDs) are traditionally associated with high volume and acuity, often resulting in longer wait times and decreased patient satisfaction. In a busy emergency department, multiple patients who are high-risk often arrive simultaneously. At a central Virginia Level I trauma center with over 80,000 annual visits, the front-end triage process was restructured as part of a departmental-defined performance improvement project. A screening nurse role was created to increase patient safety and patient satisfaction.

Implementation: An additional triage nurse was added to the current staffing model. The 24-hour/7-day a week position is staffed by a registered nurse who is located next to reception for improved visualization of patients as they enter the emergency department. All triage nurses were provided education regarding the primary functions of the role before implementation. The screening nurse performs a 30-60 second triage upon patient arrival to "all-or-none bundle" item was added to reflect the percentage of compliance with all data points in this measure. This Magnet institution performs approximately 20,000 cardiac procedures annually and quarterly treats roughly 300 patients for congestive heart failure and 65 patients for pneumonia. The triage nurse is often the first healthcare provider for these patients. The purpose of this project was to improve the identification of and provide early treatment for the pneumonia patient even when these patients present with symptoms of heart failure by achieving 100% in all seven areas of the "all-or-none bundle".

Implementation: This initiative began in May 2004. A multidisciplinary committee consisting of nurses, nurse extenders, nurse managers, a clinical nurse specialist, physicians, and secretarial staff was assembled to examine the core measures and the systems issues that could interfere with achieving compliance. This team developed a screening tool and a respiratory distress algorithm to assist the triage RN in the early identification process. This tool contains eight criteria including patient history and presenting symptoms that would place a person at an increased risk for acquiring pneumonia. These tools also serve as a communication method to the charge nurse and emergency department physician. The triage algorithm was created to initiate order sets in triage including the drawing of blood cultures. Pre-mixed antibiotics were added to the unit-based Pyxis. Discharge instructions were revised to include smoking cessation counseling. Education via staff meetings and in-services was provided for all ED staff. The triage screening tool was initiated into practice in mid-2005 and has been modified several times.

Outcomes: All-or-none bundle compliance in the fourth quarter of 2005 was 39%. Most recently (fourth quarter 2006) the "all-or-none bundle" compliance was 80%, while having achieved at least an 88% in six of the seven data points (achieving 100% in two data points). These scores are above all thresholds established by JCAHO and CMS. The presence of one outlier for antibiotic selection in intensive care unit patients resulted in lowering the "all-or-none bundle" compliance. Although a year of reminders and education failed to yield significant improvement in all areas, the educational methods used were effective when accompanied by the screening tool developed by the above-mentioned multidisciplinary team.

Recommendations: Early identification and treatment of community-acquired pneumonia improves patient outcomes and resource utilization. This project proved to be empowering to the nursing staff since many of the interventions could be facilitated by their best practice. The emergency department staff is very knowledgeable of the core measures and continues to seek opportunities to meet these practice standards. This organization has made many gains in the early identification and treatment of community acquired pneumonia and has recently made a commitment to also provide early vaccination during the acute phase of illness. The program will continue to be monitored for both positive and negative outcomes and revised as needed.
Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleEarly Identification and Treatment of Community Acquired Pneumoniaen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162661-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Early Identification and Treatment of Community Acquired Pneumonia</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2007</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Kostel-Donlon, Nancy, RN, BC, MSN, CEN, CCRN, CPAN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">St. Francis Hospital ? The Heart Center</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Clinical Nurse specialist</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">100 Port Washington Blvd., Roslyn, NY, 11576, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">(516) 562-6000, ext. 5012</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">Nancy.Kostel-Donlon@chsli.org</td></tr><tr><td colspan="2" class="item-abstract">[Clinical Poster] Clinical Topic: Community-acquired pneumonia, which afflicts millions of people annually, is defined as clinical evidence of pneumonia that occurs in individuals who are residing in the community and who have not been hospitalized in the past seven days. The Joint Commission on the Accreditation of Health Care Organizations (JCAHO) and the Centers for Medicare &amp; Medicaid Services (CMS) have published data that ranks organizations according to their compliance with the core measures of community acquired pneumonia that include: oxygen assessment, timeliness of blood cultures and antibiotics, antibiotic selection, influenza and pneumonia vaccination, and smoking cessation counseling. Recently, an [Clinical Poster] Clinical Topic: Academic emergency departments (EDs) are traditionally associated with high volume and acuity, often resulting in longer wait times and decreased patient satisfaction. In a busy emergency department, multiple patients who are high-risk often arrive simultaneously. At a central Virginia Level I trauma center with over 80,000 annual visits, the front-end triage process was restructured as part of a departmental-defined performance improvement project. A screening nurse role was created to increase patient safety and patient satisfaction.<br/><br/>Implementation: An additional triage nurse was added to the current staffing model. The 24-hour/7-day a week position is staffed by a registered nurse who is located next to reception for improved visualization of patients as they enter the emergency department. All triage nurses were provided education regarding the primary functions of the role before implementation. The screening nurse performs a 30-60 second triage upon patient arrival to &quot;all-or-none bundle&quot; item was added to reflect the percentage of compliance with all data points in this measure. This Magnet institution performs approximately 20,000 cardiac procedures annually and quarterly treats roughly 300 patients for congestive heart failure and 65 patients for pneumonia. The triage nurse is often the first healthcare provider for these patients. The purpose of this project was to improve the identification of and provide early treatment for the pneumonia patient even when these patients present with symptoms of heart failure by achieving 100% in all seven areas of the &quot;all-or-none bundle&quot;. <br/><br/>Implementation: This initiative began in May 2004. A multidisciplinary committee consisting of nurses, nurse extenders, nurse managers, a clinical nurse specialist, physicians, and secretarial staff was assembled to examine the core measures and the systems issues that could interfere with achieving compliance. This team developed a screening tool and a respiratory distress algorithm to assist the triage RN in the early identification process. This tool contains eight criteria including patient history and presenting symptoms that would place a person at an increased risk for acquiring pneumonia. These tools also serve as a communication method to the charge nurse and emergency department physician. The triage algorithm was created to initiate order sets in triage including the drawing of blood cultures. Pre-mixed antibiotics were added to the unit-based Pyxis. Discharge instructions were revised to include smoking cessation counseling. Education via staff meetings and in-services was provided for all ED staff. The triage screening tool was initiated into practice in mid-2005 and has been modified several times.<br/><br/>Outcomes: All-or-none bundle compliance in the fourth quarter of 2005 was 39%. Most recently (fourth quarter 2006) the &quot;all-or-none bundle&quot; compliance was 80%, while having achieved at least an 88% in six of the seven data points (achieving 100% in two data points). These scores are above all thresholds established by JCAHO and CMS. The presence of one outlier for antibiotic selection in intensive care unit patients resulted in lowering the &quot;all-or-none bundle&quot; compliance. Although a year of reminders and education failed to yield significant improvement in all areas, the educational methods used were effective when accompanied by the screening tool developed by the above-mentioned multidisciplinary team. <br/><br/>Recommendations: Early identification and treatment of community-acquired pneumonia improves patient outcomes and resource utilization. This project proved to be empowering to the nursing staff since many of the interventions could be facilitated by their best practice. The emergency department staff is very knowledgeable of the core measures and continues to seek opportunities to meet these practice standards. This organization has made many gains in the early identification and treatment of community acquired pneumonia and has recently made a commitment to also provide early vaccination during the acute phase of illness. The program will continue to be monitored for both positive and negative outcomes and revised as needed.</td></tr></table>en_GB
dc.date.available2011-10-27T10:31:59Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:31:59Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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