Inpatient breakout room

[Karen Stockholm]

Hello, to everyone. This is Karen Stockholm just wanting to see how many hospitals are interested in chatting about quality improvement initiatives, sharing what you have done, mentoring those who might need some assistance, posting tools, etc. The topic doesn't really matter, lets just get together and make it happen.

[mgriffith]

I'm interested - I'm new to this position and can use any ideas and support from anyone. Thanks

[Karen Stockholm]

Thanks, Mary for your reply and interest. I think I am going to have an e-mail sent to all HCQIP Liaisons and see if we can generate more interest and postings in this room. Karen

[Karen Stockholm]

Please sign in. Post a question or comment. As soon as we are all here, we can begin. Karen

[Karen Stockholm]

Hello Mary. I am just waiting for other people to sign on. How is the new position going?

[mgriffith]

It's a lot to learn. I came after the person before me left, so I have had to do a lot of learning this on my own. There have been a lot of changes right as I came on as well with the pneumonia measures changing. We use a vendor for this and use the screening tool from them. I do have a few questions for you.

[Karen Stockholm]

Still waiting. There should be at least 3 or 4 more hospitals signing in. Lets hope they do. This is the first time JENY has been used as a meeting site.

[Karen Stockholm]

Hi, Lulu, welcome. There are still a couple more hospitals who said they would join us. Mary Griffith is here with us, also. Either one of you can start us off with a question or comment. Do you both know how to post a question or reply? You should have a "post reply" button showing on your screen. My thought is to use this like a chat room, so to speak.

[Lulu]

Hello, to everyone. This is Karen Stockholm just wanting to see how many hospitals are interested in chatting about quality improvement initiatives, sharing what you have done, mentoring those who might need some assistance, posting tools, etc. The topic doesn't really matter, lets just get together and make it happen.
Hi Karen, my name is Lulu and Joji from St. Barnabas Hospital. We have formed a team and it consist of 5 people ( a senior leader, 2 clinical champion, a system leader and a day-to-day leader). We're wondering how else we can improve our Pneumonia core measures especially the "initial abx consistent with current recommendations". We have some physicians who disagree with the current recommendations for nursing home pts and immunocompromised patients admitted with pneumonia.

[Karen Stockholm]

The current guidelines are available on the IPRO website but I will send them to you. The main thing is to tell your physicians that these are "guidelines". They are not meant to be a pneumonia cookbook. There is a list of acceptable antibiotics to use and these are broken down into ICU, non-ICU, pseudomonal risk patients, and immunocompromised patients. Tell them to choose from the category of antibiotics, quinolones, beta-lactams, etc. and you will meet the requirements.

[Lulu]

Hi Mary, welcome to ipro collaborative for core measures. How are you managing the pneumonia core measure especially the "initial Abx given according to current recommendations".

[Karen Stockholm]

Just another thought, Lulu. If you go the the Main Conference Hall, scroll down to the Sticky - archived conference calls - scroll down to the sept. 15 -pneumonia call - click on Dr. Niederman's ppt slides. You can print out these slides in which he describes the reasons behind the recommendations/guidelines. Have your physicians access the audio and the slides. This might help them.

[Karen Stockholm]

Are you both still in the breakout room ? Do either of you have any other questions or comments?

[Karen Stockholm]

If neither of you have any other comments or questions, we can sign off. I think I will still try this one more time probably the week after Thanksgiving. If you have any questions you can e-mail me at kstockholm@nyqio.sdps.org or call me at 1-800-233-0360, ext. 105. Thank you for joining me today. Karen

[mgriffith]

I did not see the bottom of this with the responses.
I do have a few questions.

Did the patient receive antibiotics within 24h prior to hospital arrival?
This information is generally without any details in the ED notes.
The Initial antibiotic start date... Does this mean given while in the hospital? or are they asking if the pt recieved antibiotics prior to arrival what start date?
Often times the patient is unable to give the exact date and time of start date.
I have been entering the start date and time from the ED antibiotics, even if the patient recieved antibiotics prior to ED visit. Is this correct?
The initial antibiotic start date seems to be asked in three different places.
PN-5
PN 3b, 5, 6
PN 6
PN-6a,b
Is this just from the form we use?

[Lulu]

Is it acceptable to give a icu patient from the nursing home without pseudomonal risk factors a combination of zosyn and azithromax.
I know that zosyn (piperacillin-tazobactam) is under antipseudomonal b-lactam.
Will we meet the criteria if we give this combination?

Our infection control dept. gives Vancomycin and Imipenem to ICU pneumonia patients from nursing home. If we add zithromax to the vanco/imipenem combination would we meet the criteria?

What about giving ICU patients (without pseudomonal risk) imipenem/zithromax combination? Is this ok.

[Karen Stockholm]

Mary to answer your questions, if I can. If the patient is from a nursing home, generally you should be able to determine that from the transfer paperwork. If it isn't there, call the nursing home and ask them. It may make a difference in the antibiotic that is ordered in the ED. If you cannot determine if the patient was on antibiotics at home prior to the ED, assume they were not on anything. The initial start date is the ED date and time that the first hospital dose of antibiotics was given. You are correct to enter the ED time and date, even if they were on antibiotics prior to coming to the ED. As youknow, that question will be asked somewhere. If you don't have the antibiotic name or how long they were on it, I believe you will just enter don't know.

The other question is who is your vendor? If you have questions about the tool, other than the CART tool, you need to call your vendor and discuss it with them.

Lulu, your first question about non-pseudomonal risk ICU from a nursing home.
Should be a beta-lactam and an advanced macrolide or a beta-lactam and a respiratory quinolone, so zosym would not be appropriate. Rocephin, claforan, unasyn or ertapenem plus zithromax would be appropriate.
They should not be using vancomycin indiscriminately. It should onlyu be for patients with a beta lactam allergy. What is their reasoning for using the vanco, imipenem?
the imipenem and zithromax for ICU patients without pseudomonal risk is okay.