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1、PneumoniacareControversiesandChallengesMeeraKelleyMDClinicalCoordinator,MRNC,Inc.TheQIOfortheCarolinasOverviewIssueswiththeindicatorsOtherbroadchallengesDiscussionApril14,20052MedicalReviewofNC,Inc.PN-1OxygenationassessmentPN-2PneumococcalvaccinationPN-3bBloodculturesPN-4Ad
2、ultsmokingcessationadvicePN-5AntibiotictimingPN-5aInitialantibioticw/in8hhospitalarrivalPN-5bInitialantibioticw/in4hhospitalarrivalPN-6aInitialantibioticselection–ICUPN-6bInitialantibioticselection–NonICUPN-7InfluenzavaccinationApril14,20053MedicalReviewofNC,Inc.PN-1Oxygena
3、tionassessmentInadequateoxygen(hypoxemia)iscommoninseverepneumoniaandisaknownmortalityriskfactor.Givingsupplementaloxygenhasbeenshowntodecreasemortalityamongpatientswithpneumonia.April14,20054MedicalReviewofNC,Inc.Controversies&Challenges OxygenationassessmentNoApril14,2005
4、5MedicalReviewofNC,Inc.PN-3bBloodculturesPublishedpneumoniatreatmentguidelinesrecommendperformanceofbloodculturesforallinpatientstooptimizetherapy.Improvedsurvivalhasbeenassociatedwithoptimaltherapy.Yieldisgreaterifthecultureiscollectedbeforeantibioticsareadministered.April
5、14,20056MedicalReviewofNC,Inc.Controversies&Challenges BloodculturesDrawnlate-afterantibioticsNotdrawnatall-notroutinelydoneforoutpatientsApril14,20057MedicalReviewofNC,Inc.PN-4Adultsmokingcessationadvice/counselingSmokingaccountsforoneoutofeveryfivedeathsintheUSandisthemos
6、timportantmodifiablecauseofprematuredeath.Smokingcessationadviceisclinicallyeffectiveandcost-effective.Hospitalizationcanbeanidealopportunityforapatienttostopsmoking.Patientswhoreceiveevenbriefsmoking-cessationadvicefromtheirphysiciansaremorelikelytoquit.April14,20058Medica
7、lReviewofNC,Inc.Controversies&Challenges SmokingcessationadviceDocumentationPreventive,longtermissuesnotroutinelyaddressedbyphysiciansApril14,20059MedicalReviewofNC,Inc.PN-5AntibiotictimingTimelyadministrationofantibiotics=improvedoutcomeamongpneumoniapatientsImprovedsurviv
8、alwithreceiptofantibioticswithin4hofadmission(Khan1990)Shorteningthetime-to-first-
