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...
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).
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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…
