Prevention For Nonsocomial Pneumonia

Paper Summary:

This paper defines nosocomial pneumonia as the development of a fever, leukocytosis, purulent sputum, and new or changes to lung infiltrates on chest x-ray within 72 hours of hospitalization. The paper explains that post-operative nosocomial pneumonia is very preventable but that frequent complications can be costly and life-threatening. The paper addresses areas of improvement for the prevention of nonsocomial pneumonia, such as research, which has shown that careful pre-operative screening can identify patients who are especially at risk for developing post-surgical pneumonia. The paper also describes evidence, which shows that use of an incentive spirometer, early ambulation after surgery as well as the use of coughing & deep breathing exercises is associated with positive post-surgical health outcomes. Tables that illustrate the data are included with the paper.

Table of Contents:
Area in Need of Improvement
Evidence-Based Plan
- Table 1. Odds Ratios of Common Post-operative Pulmonary Complications
Implementation Plan for this Process Improvement
- Table 2. Pneumonia Risk Identification
- Table 3. How to Score Patients Using the Pneumonia Risk Identification Protocol
Business Case to Support Evidenced-Based Plan
- Table 4. Cost of Current Practices
- Table 5. Cost of Implementing PRIP
- Table 6. Cost-Benefit Analysis
Conclusion

From the Paper:

"Currently Medicare has identified eight conditions that will no longer be reimbursed if a patient develops them during an inpatient stay. Those conditions are object left in patient during surgery, air embolism, blood incompatibility, catheter-associated urinary tract infection, pressure ulcer, vascular-catheter associated infection, mediastinitis after coronary-artery bypass grafting, and fall from bed [4]. Rosenthal wrote in October of 2007 that these eight conditions were identified after meeting several criteria including that the condition "could reasonably have been prevented through the application of evidence-based guidelines". Currently post-surgical pneumonia is not one the eight identified conditions, but as the number of Medicare participants increases and funds are strained, this preventable and costly condition could easily become next on Medicare's list of non-reimbursable conditions."

Sample of Sources Used:

• A.C. Pearce and R.M. Jones. (1984). Smoking and anesthesia: Preoperative abstinence and perioperative morbidity. Anesthesiology 61; 576-584.
• American College Of Chest Physicians (1999, August 16). Smokers Pneumonia Risk Three Times Greater. ScienceDaily. Retrieved November 19, 2007, from http://www.sciencedaily.com /releases/1999/08/990816073437.htm
• General anesthesia best evidence in anesthetic practice; Clinical prediction guide: a 14-item index predicts 30-day risk of postoperative pneumonia after non-cardiac surgery. Canadian Journal of Anesthesia. (2002). 49(7). 655-658.
• Ebell, M. (2007). Predicting postoperative pulmonary complications. American Family Physician. 75(12).
• Guidelines for prevention of nosocomial pneumonia. Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report. 446; 1-79.

More papers on Prevention For Nonsocomial Pneumonia:

• Article Review # 150339 : "Preventing Ventilator-Associated Pneumonia"
• Term Paper # 144634 : "Ventilator-Assisted Pneumonia in the ICU"
• Research Paper # 145330 : "Prevention of Ventilator Associated Pneumonia"

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