Changed process of patient admission and flow if diagnosed with suspected pneumonia. Utilized newly developed tools and spent time to ensure appropriate education and timing for the tools implemented.
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Developed Emergency Department (ED) triage guidelines for the RNs, to enable more rapid recognition of suspected pneumonia (PN) admissions.
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Altered ED staffing to allow for an added triage Registered Nurse (RN) to ED front desk to begin appropriate time-limited PN interventions during high volume periods.
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Educated entire ED staff with one-to-one education sessions of RN and unit assistants in the annual education blitzes to explain suspected PN parameters and expectations.
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Gave PN guideline pocket cards to over 140 staff members and also to the ED physicians. Posters with guidelines also available in ED as well as updated guidelines and reminders being emailed directly to each staff member routinely.
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Given real time feedback on each deficient chart to both ED physicians and ED RNs routinely.
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Added PN appropriate selection antibiotics to ED and specific pulmonary units PYXIS medication system.
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Developed PN clinical pathway to standardized evidenced-based PN admissions, interventions, and process.
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Developed evidenced-based PN order set that defaults to best practice for PN interventions with reasons to be noted by physicians if they chose not to implement best practice methods.
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Developed standardized PN admission and patient flow pocket guides and made available for all physicians.
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Developed standardized PN Quality Indicator sheet to be utilized by all case managers upon an admission of a PN patient.
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Standardized smoking cessation education and educational packets that are utilized by all case managers when appropriate.
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Added a pre-printed smoking cessation advisement to all patient discharge instructions, statement cannot be removed.
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Added a no smoking while hospitalized and smoking cessation advisement to all patient admission and consent for treatment forms.
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Conduct weekly chart reviews of all discharged PN patients in Performance Improvement department by clinical analysts where findings of deficiencies are placed into a real time report.
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Developed a weekly electronic distribution of the created deficiency reports that is made available for review by the Adult Medicine (AMED) Medical Director, the AMED Vice President, the PN Team Leader, pulmonary medicine unit directors, and any case manager.
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Developed policies to support implementation of all PN Quality Indicator sheets and smoking cessation advice/counseling interventions via case managers.
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Developed control charts of deficiency reports for review by bi-monthly AMED service line meetings.
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Developed control charts of finalized Centers for Medicare & Medicaid Services Hospital Quality Initiative (CMS HQI) reports to be utilized for presentation and review at monthly sub-team meetings, specifically case management and ED. Also utilized for presentation and review at the bi-monthly AMED service line meetings.
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Standardized pneumococcal and influenza screening and vaccination documentation and process.
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Changed patient MAR to keep vaccination intervention orders present until it is appropriately addressed by staff or patient is discharged. Previously, orders would automatically drop off MAR three days after patient was admitted whether or not it was addressed by staff.
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Added pneumococcal and influenza screening and vaccination to the computerized History and Physical assessment as a required field. Clinicians unable to complete assessment until this field has been completely addressed and filled in.
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Pre-checked pneumococcal and influenza screenings and vaccination on the PN order set.
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The pneumonia order set listed only antibiotics that are recommended best practice and cost-effective. These are separated into ICU and non-ICU admissions sections. The ICU Admission Order Set also reflects these selections.
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Developed evidence-based discharge order set that addresses specific needs of PN and/or respiratory patients for home care.
