肺炎护理面临问题与挑战—英文课件.pptVIP

April 14, 2005 Medical Review of NC, Inc. Pneumonia careControversies and Challenges Meera Kelley MD Clinical Coordinator, MRNC, Inc. The QIO for the Carolinas Overview Issues with the indicators Other broad challenges Discussion PN-1 Oxygenation assessment PN-2 Pneumococcal vaccination PN-3b Blood cultures PN-4 Adult smoking cessation advice PN-5 Antibiotic timing PN-5a Initial antibiotic w/in 8 h hospital arrival PN-5b Initial antibiotic w/in 4 h hospital arrival PN-6a Initial antibiotic selection – ICU PN-6b Initial antibiotic selection – Non ICU PN-7 Influenza vaccination PN-1 Oxygenation assessment Inadequate oxygen (hypoxemia) is common in severe pneumonia and is a known mortality risk factor. Giving supplemental oxygen has been shown to decrease mortality among patients with pneumonia. Controversies ChallengesOxygenation assessment No PN-3b Blood cultures Published pneumonia treatment guidelines recommend performance of blood cultures for all inpatients to optimize therapy. Improved survival has been associated with optimal therapy. Yield is greater if the culture is collected before antibiotics are administered. Controversies ChallengesBlood cultures Drawn late-after antibiotics Not drawn at all-not routinely done for outpatients PN-4 Adult smoking cessation advice/counseling Smoking accounts for one out of every five deaths in the US and is the most important modifiable cause of premature death. Smoking cessation advice is clinically effective and cost-effective. Hospitalization can be an ideal opportunity for a patient to stop smoking. Patients who receive even brief smoking-cessation advice from their physicians are more likely to quit. Controversies ChallengesSmoking cessation advice Documentation Preventive, long term issues not routinely addressed by physicians PN-5 Antibiotic timing Timely administration of antibiotics = improved outcome among pneumonia patients Improved survival with receipt of antibiotics within