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1、PneumoniacareControversiesandChallengesMeeraKelleyMDClinicalCoordinator,MRNC,Inc.TheQIOfortheCarolinasOverviewIssueswiththeindicatorsOtherbroadchallengesDiscussionApril14,20052MedicalReviewofNC,Inc.PN-1OxygenationassessmentPN-2PneumococcalvaccinationPN-3bBloodculturesPN-4Adultsmokingce
2、ssationadvicePN-5AntibiotictimingPN-5aInitialantibioticw/in8hhospitalarrivalPN-5bInitialantibioticw/in4hhospitalarrivalPN-6aInitialantibioticselection–ICUPN-6bInitialantibioticselection–NonICUPN-7InfluenzavaccinationApril14,20053MedicalReviewofNC,Inc.PN-1OxygenationassessmentInadequate
3、oxygen(hypoxemia)iscommoninseverepneumoniaandisaknownmortalityriskfactor.Givingsupplementaloxygenhasbeenshowntodecreasemortalityamongpatientswithpneumonia.April14,20054MedicalReviewofNC,Inc.Controversies&Challenges OxygenationassessmentNoApril14,20055MedicalReviewofNC,Inc.PN-3bBloodcul
4、turesPublishedpneumoniatreatmentguidelinesrecommendperformanceofbloodculturesforallinpatientstooptimizetherapy.Improvedsurvivalhasbeenassociatedwithoptimaltherapy.Yieldisgreaterifthecultureiscollectedbeforeantibioticsareadministered.April14,20056MedicalReviewofNC,Inc.Controversies&Chal
5、lenges BloodculturesDrawnlate-afterantibioticsNotdrawnatall-notroutinelydoneforoutpatientsApril14,20057MedicalReviewofNC,Inc.PN-4Adultsmokingcessationadvice/counselingSmokingaccountsforoneoutofeveryfivedeathsintheUSandisthemostimportantmodifiablecauseofprematuredeath.Smokingcessationad
6、viceisclinicallyeffectiveandcost-effective.Hospitalizationcanbeanidealopportunityforapatienttostopsmoking.Patientswhoreceiveevenbriefsmoking-cessationadvicefromtheirphysiciansaremorelikelytoquit.April14,20058MedicalReviewofNC,Inc.Controversies&Challenges SmokingcessationadviceDocumenta
7、tionPreventive,longtermissuesnotroutinelyaddressedbyphysiciansApril14,20059MedicalReviewofNC,Inc.PN-5AntibiotictimingTimelyadministrationofantibiotics=improvedoutcomeamongpneumoniapatientsImprovedsurvivalwithreceiptofantibioticswithin4hofadmission(Khan1990)Shorteningthetime-to-first-
