Quality Care for Pneumonia

Patients experiencing pneumonia should expect to receive the following standard treatments:

• Blood culture taken prior to antibiotic
• Antibiotic within eight hours
• Oxygenation assessment within 24 hours
• Advice for smokers on how to stop smoking

The Centers for Medicare & Medicaid Services and the Joint Commission for the Accreditation of Healthcare Organizations have determined that the treatments listed above are indicators of quality care for pneumonia. Look for and expect these treatments at the hospital.

Treating pneumonia

When you go the hospital or emergency room for pneumonia, a nurse or physician should give you prompt attention that includes a physical exam. In order to start your treatment as quickly as possible, several steps need to be done. Your doctor will need to examine you, order tests, make a diagnosis of pneumonia, and choose the best antibiotic for your condition.

• Blood Culture
  A blood culture should be done before you receive an antibiotic. Blood cultures are tests performed on samples of blood to check for infection. They can also detect the bacteria or other germs causing  the infection to help determine the best course of treatment for you. In patients with pneumonia, the infection in the lungs can spread to the blood. When this happens, the patient's condition can worsen if not detected and treated early.
  
  What to expect: A lab technician or nurse will take two blood samples from two different locations for accuracy. If you are given antibiotics before blood samples have been taken, ask your doctor or nurse why blood cultures were not obtained. There may be a good reason, such as the need to get the antibiotics started right away, or if  you were already on antibiotics before coming to the hospital.
  

• Antibiotic
  Patients with pneumonia usually take an antibiotic to get rid of the infection. An antibiotic is a medication designed to kill the bacteria or other germs that causes pneumonia. Viruses can also cause pneumonia, but they are rarely susceptible to antibiotics. Studies show that seniors who receive antibiotics within eight hours of hospital arrival have an increased chance of survival.
  
  What to expect: After an antibiotic has been ordered, you should receive the first dose quickly. If you are in the emergency room, the emergency room might have a supply of antibiotics on hand, so the doctor would not have to wait for an order to be processed at the hospital pharmacy.
  
  Hospitalized patients may receive antibiotics through the veins (intravenously), but antibiotics can also be taken by mouth (orally). Sometimes, you may stay in the hospital receiving  intravenous antibiotics for two or three days, then go home to recover on oral medicine.
  
  Note that after the results of the blood culture are returned, the doctor may change the drugs you are given in order to fight the infection better.

• Oxygenation assessment
  All pneumonia patients should have their blood oxygen level checked within eight hours of admission to the hospital. Measuring the oxygen level in the blood of patients with pneumonia helps the doctor determine the severity of the pneumonia, the need for extra oxygen, and whether the patient should be admitted to the hospital.
  
  Studies show that providing extra oxygen to certain people with pneumonia who have low blood oxygen levels can decrease risk of death. Pneumonia weakens the lungs’ ability to exchange oxygen for carbon dioxide, causing the body to receive too little oxygen. This lack of oxygen can kill tissue as well as making it difficult to breathe. If left untreated, it may lead to death.
  
  You also may receive treatments to make you more comfortable, such as oxygen and medicine for coughing and chest discomfort. Oxygen may be given through a small tube in your nose, or a mask over your nose and mouth.
  
  What to expect: You should receive either a blood test called an arterial blood gas or a pulse-oximetry, which detects oxygen through a sensor placed on your finger or ear lobe. If you have rapid, gasping breaths, the hospital should test your blood immediately because your body may not be receiving the oxygen it needs.
  
  If you have a chronic lung disease, such as emphysema and chronic obstructive pulmonary disease, you may not receive extra oxygen. In this case, ask your doctor if you should receive oxygen.

• Advice to stop smoking
  Smokers who stop smoking can improve the way their lungs work. You can ask a doctor or nurse for information about quitting and whether there are classes or programs you can attend. You may want to ask them about medications that will help you quit and if the medications would be appropriate for you.
  
  What to expect: If you smoke, you should receive counseling during a hospital stay on how to quit smoking. The hospital staff may tell you about classes, group sessions, reading materials, or medications available to help you.