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.
You should become familiar with the
performance measurements and outcomes shown on this site to
answer questions from your Board, staff, practitioners, and
patients regarding your hospital’s
record regarding the core measures for pneumonia. |