2.50
Hdl Handle:
http://hdl.handle.net/10755/164271
Category:
Abstract
Type:
Presentation
Title:
Improving the Care of the Patient with Pneumonia: The Focus Continues
Author(s):
DiNella, Jeannine; Ervin, Kelly; Santarelli, Debra; Skledar, Susan
Author Details:
Jeannine DiNella, MSN, RN, CNS, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA, email: nacnsorg@nacns.org; Kelly Ervin, CPhT; Debra Santarelli, MS, RN,BSN, CNAA-BC; Susan Skledar, RPh, MPH
Abstract:
Purpose: "The aim of this quality improvement project is to improve the care of the patient with community acquired pneumonia (CAP) and achieve top tier (>90%) compliance with established evidence-based core measure indicators. The institution is sustaining achievement in improving the care of the patient with pneumonia with specific emphasis on the following process indicator measures: Oxygenation should be assessed within 24 hours of hospital arrival. Blood cultures should be drawn prior to initiating antibiotics Antibiotics should be given within 4 hours of hospital arrival. Smoking cessation information provided to patients. Pneumococcal polysaccharide and influenza vaccine given before discharge. Significance: CAP is the 5th leading cause of death in patients > 65 years of age with approximately 60,000 deaths per year. There are one million annual pneumonia admissions and 75% of patients come through the Emergency Department. Design: The institution focuses on CAP to improve the quality of patient care and to satisfy the Centers for Medicare and Medicaid Services and JCAHO hospital core quality reporting measures. According to the Pennsylvania Elderly Immunization Act, it is required that healthcare institutions offer immunizations to hospitalized elderly prior to their discharge. Methods: Specific emphasis in 2006 was placed on antibiotic timing, comprehensive identification of patients, and daily vigilance of ensuring compliance with recommended care measures. A multidisciplinary work group consisting of a Clinical Nurse Specialist (CNS), Pharmacy, Nursing, Medical Teams, and Quality Improvement Team continued to meet monthly to improve processes of care. The CAP patient admission process through the Emergency Department(ED) was expanded for all hospital admissions to ensure that the 1st antibiotic dose was given within 4 hours of hospital arrival. The patient is identified as a CAP in the outpatient physician office. The physician notifies admitting for patient placement in the ED. In turn, the patient is sent directly to the ED for evaluation and given the first dose of antibiotics. A Healthy Lifestyle brochure was created in 2005 to educate patients, focusing on smoking cessation. Currently, we have a new computerized order entry system and smoking assessment and brochure are documented by nursing. Computerized reports were created, such as daily transfer and drug utilization reports to identify CAP patients and influenza patients for vaccination opportunity through pharmacy standing orders. The daily transfer report entails patients who have been transferred within the last 24 hours and drug utilization reports entail inpatients that are prescribed particular drugs such as azithromycin. Orders are then placed on the patients chart daily. Changes occurred with the standing order as well. A NOW administration order was added so nursing could capture patients before discharge. Existing documentation forms were also modified for clarity. To help sustain improvements, a CNS continued to round daily on pneumonia patients to ensure compliance and educate patient, families, and nurses. In addition, we have a quality improvement nurse who audits charts and our pharmacy sends a daily notice to the clinical directors and primary nurses to alert them that orders have been placed. For identified areas of variance from core measure best practice targets, our physician champion educated the medical staff. Findings: Compliance with obtaining oxygenation assessment was sustained at >99% over fiscal year (FY) 2005-2007. Patients receiving their first dose of antibiotic within 4 hours of hospital arrival improved from 73.7%, 75.4%, and 92.8%, in FY05, 06, and 07 (to-date), respectively. The goal of 240 minutes (4 hours) was exceeded, with our FY07 average of 141 minutes for patients to receive their first antibiotic dose. Patients receiving information on smoking cessation improved from 78.6%(FY05) to 94.5% (FY07). Vaccination rates for pneumococcal polysaccharide increased from 75% (FY05) to 90.4% (FY07), respectively. Although not a JCAHO core measure, influenza vaccine administration rates more than doubled from FY05 to FY07, increasing from 36.8% to 76.4%. Conclusions: By continued focus on the care of the patient with CAP, compliance with core quality measures for UPMC has reached national top tier reporting goals. Process changes such as direct ED admission for antibiotics, computerized patient identification tools, provision of patient education materials, continued vaccine standing orders program, and CNS monitoring has helped to achieve these best practice goals.Implications for Practice: Our continued actions will include interdisciplinary daily efforts to maintain and increase compliance to top tier reporting for all core measure indicators. The CNS will continue to increase front line staff awareness of core measures and the need for good compliance. Our next step will include automatic screening processes and core measure patient identification in Computerized Physician Order Entry. This in turn will identify patients at admission vs. 24 hours after.
Repository Posting Date:
27-Oct-2011
Date of Publication:
27-Oct-2011
Conference Date:
2008
Conference Name:
Clinical Nurse Specialists: Leaders in Clinical Excellence
Conference Host:
NACNS - National Association of Clinical Nurse Specialists
Conference Location:
Atlanta, Georgia, USA
Description:
Conference theme: Clinical Nurse Specialists: Leaders in Clinical Excellence, held March 5 - 8 at the Westin Peachtree Plaza in Atlanta, Georgia
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_US
dc.typePresentationen_GB
dc.titleImproving the Care of the Patient with Pneumonia: The Focus Continuesen_GB
dc.contributor.authorDiNella, Jeannineen_US
dc.contributor.authorErvin, Kellyen_US
dc.contributor.authorSantarelli, Debraen_US
dc.contributor.authorSkledar, Susanen_US
dc.author.detailsJeannine DiNella, MSN, RN, CNS, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA, email: nacnsorg@nacns.org; Kelly Ervin, CPhT; Debra Santarelli, MS, RN,BSN, CNAA-BC; Susan Skledar, RPh, MPHen_US
dc.identifier.urihttp://hdl.handle.net/10755/164271-
dc.description.abstractPurpose: "The aim of this quality improvement project is to improve the care of the patient with community acquired pneumonia (CAP) and achieve top tier (>90%) compliance with established evidence-based core measure indicators. The institution is sustaining achievement in improving the care of the patient with pneumonia with specific emphasis on the following process indicator measures: Oxygenation should be assessed within 24 hours of hospital arrival. Blood cultures should be drawn prior to initiating antibiotics Antibiotics should be given within 4 hours of hospital arrival. Smoking cessation information provided to patients. Pneumococcal polysaccharide and influenza vaccine given before discharge. Significance: CAP is the 5th leading cause of death in patients > 65 years of age with approximately 60,000 deaths per year. There are one million annual pneumonia admissions and 75% of patients come through the Emergency Department. Design: The institution focuses on CAP to improve the quality of patient care and to satisfy the Centers for Medicare and Medicaid Services and JCAHO hospital core quality reporting measures. According to the Pennsylvania Elderly Immunization Act, it is required that healthcare institutions offer immunizations to hospitalized elderly prior to their discharge. Methods: Specific emphasis in 2006 was placed on antibiotic timing, comprehensive identification of patients, and daily vigilance of ensuring compliance with recommended care measures. A multidisciplinary work group consisting of a Clinical Nurse Specialist (CNS), Pharmacy, Nursing, Medical Teams, and Quality Improvement Team continued to meet monthly to improve processes of care. The CAP patient admission process through the Emergency Department(ED) was expanded for all hospital admissions to ensure that the 1st antibiotic dose was given within 4 hours of hospital arrival. The patient is identified as a CAP in the outpatient physician office. The physician notifies admitting for patient placement in the ED. In turn, the patient is sent directly to the ED for evaluation and given the first dose of antibiotics. A Healthy Lifestyle brochure was created in 2005 to educate patients, focusing on smoking cessation. Currently, we have a new computerized order entry system and smoking assessment and brochure are documented by nursing. Computerized reports were created, such as daily transfer and drug utilization reports to identify CAP patients and influenza patients for vaccination opportunity through pharmacy standing orders. The daily transfer report entails patients who have been transferred within the last 24 hours and drug utilization reports entail inpatients that are prescribed particular drugs such as azithromycin. Orders are then placed on the patients chart daily. Changes occurred with the standing order as well. A NOW administration order was added so nursing could capture patients before discharge. Existing documentation forms were also modified for clarity. To help sustain improvements, a CNS continued to round daily on pneumonia patients to ensure compliance and educate patient, families, and nurses. In addition, we have a quality improvement nurse who audits charts and our pharmacy sends a daily notice to the clinical directors and primary nurses to alert them that orders have been placed. For identified areas of variance from core measure best practice targets, our physician champion educated the medical staff. Findings: Compliance with obtaining oxygenation assessment was sustained at >99% over fiscal year (FY) 2005-2007. Patients receiving their first dose of antibiotic within 4 hours of hospital arrival improved from 73.7%, 75.4%, and 92.8%, in FY05, 06, and 07 (to-date), respectively. The goal of 240 minutes (4 hours) was exceeded, with our FY07 average of 141 minutes for patients to receive their first antibiotic dose. Patients receiving information on smoking cessation improved from 78.6%(FY05) to 94.5% (FY07). Vaccination rates for pneumococcal polysaccharide increased from 75% (FY05) to 90.4% (FY07), respectively. Although not a JCAHO core measure, influenza vaccine administration rates more than doubled from FY05 to FY07, increasing from 36.8% to 76.4%. Conclusions: By continued focus on the care of the patient with CAP, compliance with core quality measures for UPMC has reached national top tier reporting goals. Process changes such as direct ED admission for antibiotics, computerized patient identification tools, provision of patient education materials, continued vaccine standing orders program, and CNS monitoring has helped to achieve these best practice goals.Implications for Practice: Our continued actions will include interdisciplinary daily efforts to maintain and increase compliance to top tier reporting for all core measure indicators. The CNS will continue to increase front line staff awareness of core measures and the need for good compliance. Our next step will include automatic screening processes and core measure patient identification in Computerized Physician Order Entry. This in turn will identify patients at admission vs. 24 hours after.</td></tr></table>en_GB
dc.date.available2011-10-27T11:45:14Z-
dc.date.issued2011-10-27en_GB
dc.date.accessioned2011-10-27T11:45:14Z-
dc.conference.date2008en_US
dc.conference.nameClinical Nurse Specialists: Leaders in Clinical Excellenceen_US
dc.conference.hostNACNS - National Association of Clinical Nurse Specialistsen_US
dc.conference.locationAtlanta, Georgia, USAen_US
dc.descriptionConference theme: Clinical Nurse Specialists: Leaders in Clinical Excellence, held March 5 - 8 at the Westin Peachtree Plaza in Atlanta, Georgiaen_US
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.en_US
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