Best Practices - PNE

The Centers for Medicare & Medicaid Service (CMS) and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) together developed core measures to be used to increase quality of care for AMI patients. The measures related to treatment to pneumonia are:

• Measuring the oxygen blood levels
• Performing the recommended blood test
• Giving antibiotics in a timely fashion
• Providing advice/counseling on how to stop smoking
• Before discharge, screening and vaccinating against pneumonia

The successful treatment of pneumonia, as with many diseases, relies on early detection and quality treatment. To maximize the likelihood of survival after the onset of pneumonia symptoms, patients need to receive antibiotics within four hours. Effective treatment provides timely and consistent antibiotic administration, blood culture collection, oxygenation assessment, influenza and pneumococcal immunization, and smoking cessation counseling. Adults aged 65 and older should receive the influenza and pneumococcal immunization to prevent pneumonia and its complications.

Care delivered in a hospital is the result of a number of people interacting within a complex system. For patients, the broad outlines of pneumonia prevention and treatment are reflected in the CMS/JCAHO core measures. Staff working to deliver care can examine the evidence-based guidelines to help create a standard document reflecting the care at their hospital that would conform to the performance measures

The Maryland Health Care Commission in coordination with CMS and JCAHO recommend Hospital Leaders employ the following best practices:

• Use guidelines and care pathways to standardize the process of caring for people with pneumonia  
  
  A process is a series of activities that achieves a result. It follows through with defining a process, identifying needed materials, and charting the flow of the current process. The ultimate goal of defining a process is identifying problems in the current process. Those people responsible for the process must be involved in flowcharting the process and developing improvements. See “Current Process Analysis Tool” [PNE_RS2A_RI_Current Process Analysis[1].doc] for guidance on standardizing processes.

• Use technology to manage patient care processes 
  
  Electronic information systems can document and disseminate the successes and failures in the treatment of pneumonia in a way that can be used to augment the process of treatment. Electronic information systems allow providers to gather information from many sources and incorporate timely analysis from within a facility or from outside organizations.

• Use electronic prompts as evidence-based reminders  
  
  Electronic prompts serve as a reminder of evidence-based guidelines for providers in the treatment and prevention of pneumonia. These prompts can be displayed on the electronic medical record screen or automatically printed out for the medical record. For information technology to be a successful tool, users of data collection tools need to be provided with timely technical support, including concrete answers, relevant supporting documents (data dictionaries), and expedient replies.

• Use visual prompts and reminders to support the use of core measures in the hospital, including infectious diseases chart stickers, documentation stickers, posters, pocket cards, follow-up mailers and indicator logic. See examples:

• Pneumococcal reminder [Pneumonia Risk Poster[1].pdf]
• Smoking cessation advice [Smoking Stop Sign Poster.pdf]    
• Smoker advice chart sticker [Smoking Stop Sign Sticker.pdf]
• Smoking cessation pocket card [Smoking Pocket Card[1].pdf]
• Smoking cessation chart sticker [Smoking Cessation Chart Sticker[1].pdf]
• Smoking cessation mailer [Smoker Acknowledgement.pdf]
• Smoking cessation indicator logic [Quick Reference Guide.pdf]

In addition, the Medicare Quality Improvement Community suggests the following hospital quality improvement activities for pneumonia. Follow the Quality Improvement links for administrators the Medicare Quality Improvement Community website: www.medqic.com.

• Identify and encourage a physician champion to influence colleagues to adopt and develop evidence-based practices
• Provide healthcare workers education about the evidence-based antibiotic recommendations for pneumonia
• Use a storytelling method to convey “what works” in successful care strategies
• Convert current available science into quick reference tools for pneumonia.

To help Hospital Leaders improve their care for patients with pneumonia, many on-line tools are available including these:

• The National Pneumonia Medicare Quality Improvement Project publishes the “Pneumonia Collaborative Framework” that describes a plan and measurement strategy for improving the care of patients with pneumonia. Versions of the document are available in .pdf and .doc format from the website for the Medicare Quality Improvement Community.
  

• The Advisory Committee on Immunization Practices, from the Centers for Disease Control and Prevention, gives recommendations on vaccination processes in the article “Use of Standing Orders Programs to Increase Adult Vaccination Rates.” The article is available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr4901a2.htm

• The American Lung Association provides a free online smoking cessation program that uses multiple modules to help a patient give up smoking. The program, called Freedom From Smoking® Online, is accessed through their website, by clicking on the FFS Online Program link, at: http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=33484

Through this website, Maryland patients, providers, and other hospital executives can research the quality of care for patients with pneumonia at all Maryland hospitals, choosing the one that fits their needs best.