Pneumonia and Timely Antibiotic Therapy

Pneumonia and Timely Antibiotic Therapy The purpose of this project to educate hospital staff concerning the fact that research supports a best practice protocol that pneumonia patients should be provided with antibiotics within 4 hours of being admitted to the hospital. Pneumonia is defined by Evans and Tippins (2007) as being "an acute inflammation of the lower respiratory tract most commonly due to viral and bacterial infection. Areas or lobes of the lungs become consolidated resulting in an impairment of gas exchange" (p. 224).

The environment of the project is a tertiary hospital facility that provides surgical, medical and rehabilitation services. The question is whether pneumonia patients should be given antibiotics within a certain time frame, such as 4 hours after being admitted to the hospital. At present, pneumonia remains the leading cause of death attributable to infection in patients aged 65 years and older and accounts for 13% to 48% of infections in the nursing home setting, with mortality rates as high as 55% (Solh, Akinnusi, & Alfarah, et. al., 2009).

Community-acquired pneumonia (CAP) is a common condition which also has a significant mortality rate. The management of a patient with CAP is centered on assessment and correction of gas exchange and fluid balance together with administration of appropriate antibiotics (Finch, & Woodhead, 1998). The goal of this project is to improve compliance rates with hospital policies that require the administration of antibiotics within 4 hours of admission.

This goal is congruent with the guidance from the Joint Commission and Centers for Medicare and Medicaid Services which stipulates that patients admitted to the hospital with an initial diagnosis of pneumonia should receive an initial antibiotic dose within 4 hours following their arrival at the hospital (Four Hours to Start…, 2006).

Nurses and doctors working in hospitals are required to apply the core measures that have been implemented by the hospital policy in carrying out assigned tasks to meet standards of care to qualify the hospital for better pay under the Value-Based Purchasing directive initiated by the Centers for Medicare and Medicaid, also known as Medicare insurance. Moreover, the standards require 100% compliance with this practice and state that federal reimbursements will be tied to hospitals' performance levels (Four Hours to Start…, 2006).

At present, around 1.2 million patients are hospitalized each year in the United States with pneumonia and inpatient mortality rates average 5.8% (Lindenauer, Behal, & Murray et al., 2006). The economic consequences of the healthcare services are staggering, and pneumonia-related admissions cost more than $20 billion in direct health care costs annually (Lindenauer et al., 2006). Currently, pneumococcal disease is the most prevalent form of community-acquired pneumonia in older adults which represents a substantial clinical and economic burden, as well as exacerbating existing COPD conditions (Ludwig & Unal, 2012).

Opportunities to improve the care of patients with pneumonia, though, have been well documented at both the state and national levels (Lindenauer et al., 2006). For example, the timeliness of antibiotic administration and the selection of antibiotics are suboptimal, despite the dissemination of national guidelines and results in a higher morbidity for these patients (Lindenauer et al., 2006).

Essential hospital-based prevention strategies and common strategies used by hospitals involve the establishment of clinical practice guidelines, the development of standard order sets and reminder systems, and the use of measurement of and feedback on performance which improves the care of this patient population (Lindenauer et al., 2006).

Therefore, the results that emerge from this project should be of interest to all stakeholders including hospital staff, doctors, nurses, patients, and anyone who pays for healthcare such as insurance companies and taxpayers because the government pays for healthcare through Medicare, as well as government policy makers to allocate funding for the Medicare program. In sum, it has been shown that administration of antibiotics within 4 hours can prevent deaths in the Medicare population, offers cost savings for hospitals, and is feasible for most inpatients (Houck, Bratzler, Nsa & Ma, 2007). 2.

Dissemination goals Ultimately, the dissemination goals for this project are to reach all clinicians with the 4-hour message in order to improve related patient outcomes; however, the goals are also to change practice and implement a policy whereby hospital staff identifies early on in the process those patients who are most likely to have pneumonia and implement "standing orders" or "delegated orders" or "core measures" in response.

These steps are a predetermined set of treatment guidelines that are established based on evidence that has been researched that dictate to hospital staff their responsibility in carrying out antibiotic therapy within a certain time frame that has been proven through evidence-based research to improve the outcome of patients with pneumonia who come to the hospital. 3. Target audiences Hospital staff such as doctors and nurses with the following priorities: A.

The primary audience will be the hospital staff in the emergency room and nursing staff and doctors on the floors of the hospital who receive "direct admission patients" who are the first to contact the patients coming into the hospital. This is where the clock starts ticking and pneumonia cases need to be identified early. B.

The secondary audiences would be beside nurses who continue with "in patient" care after admission to the hospital as well as ancillary personnel such as nurses aids, the radiology department who view the patients lungs on x-ray and laboratory department who take blood culture specimens and other ancillary departments that contribute to the patients work up. 4. Key messages Administering antibiotics to patients with pneumonia within 4 hours of their admission helps reduce mortality rates and will help improve hospital reimbursement for such cases. 5.

Sources/messengers Doctors and nurses as well as Department Directors who are the "bosses" of each department in the hospital such as the emergency department and the intensive care department. In order to get these stakeholders "on board" with this initiative, the project will include a PowerPoint presentation to show in each department's "monthly unit meeting" and post a flyer on each department's bulletin board in their nurses break room. In addition, the results will also be emailed to all departments in the hospital for further dissemination. 6.

Dissemination activities, tools, timing, and responsibilities The main tool that will be used to achieve the above-stated dissemination goals will be the above-described PowerPoint presentation that will support these activities. Team members will consist of the Director's of each Department to help organize the power point presentation at their next "Monthly Unit Meeting" in which all of their staff attend to hear necessary information being introduced to their department that affect how they perform their duties.

In addition, a "feed-back" box will be placed in each department's break room together with pens and.