You now have 2 extra hours for antibiotics
You now have 2 extra hours for antibiotics
Diagnosis sometimes takes time
In 2004, The Joint Commission issued a standard requiring that ED patients be given an antibiotic within four hours of presentation if they are discharged with a diagnosis of pneumonia. As of October 2007, the time frame has since been increased to six hours. Also, The Joint Commission is allowing EDs to document "diagnostic uncertainty" to indicate that the diagnosis of pneumonia was not clear at the time of the patient's arrival in the ED.
"There is no evidence that supports that outcomes at four hours are better than six hours," says Cheryl Webber, RN, MS, CEN, nurse manager of the ED at Tufts Medical Center in Boston. "You don't want to do a knee-jerk response and treat everyone with antibiotics. Sometimes it takes time to make the diagnosis."
It might not be possible to give the antibiotics even within the six-hour timeframe in some cases, she adds. For example, if congestive heart failure is a possible diagnosis, you have to wait longer to make a decision. "There are a lot of variables involved," says Webber. "If it's an unstable patient, it's a no-brainer. But if it's a stable patient, you may have delays in getting an X-ray. You can only work with the resources you have."
Right now, the ED is between 85% and 95% compliance with the four-hour time frame, says Webber. She attributes this high level of compliance to giving nurses constant feedback.
"We are always letting them know how they are doing," she says. "We send e-mails monthly to all the ED staff. I list every nurse and doctor involved in the care of pneumonia patients, and if they got the antibiotics in less than two hours, I highlight those names and thank them for improving patient care." Webber also does her own internal audit of every patient admitted from the ED with pneumonia.
Webber identified a documentation problem with their electronic record, involving ED nurses indicating that they gave antibiotics before drawing blood cultures, when in reality, the practice occurred in the opposite order. "Even though they generally draw blood cultures when the IV is started, they didn't document that," says Webber. "It wasn't valid information, so we had to change our documentation tool. They are now required to enter the time the blood was drawn."
In 2004, The Joint Commission issued a standard requiring that ED patients be given an antibiotic within four hours of presentation if they are discharged with a diagnosis of pneumonia. As of October 2007, the time frame has since been increased to six hours. Also, The Joint Commission is allowing EDs to document "diagnostic uncertainty" to indicate that the diagnosis of pneumonia was not clear at the time of the patient's arrival in the ED.Subscribe Now for Access
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