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Pneumonia prevention and treatment

Pneumonia: By the Numbers

Pneumonia is one of the top ten causes of readmission.


people die from the disease each year in the U.S.


of all episodes of sepsis and septic shock are caused by pneumonia


visits to the ER list pneumonia as the primary diagnosis

  • Chronic lung disease (COPD, bronchiectasis, cystic fibrosis)
  • Cigarette smoking
  • Dementia, stroke, brain injury, cerebral palsy or other brain disorders
  • Immune system problems (during cancer treatment, or due to HIV/AIDS, organ transplant or other diseases)
  • Other serious illnesses, such as heart disease, liver cirrhosis or diabetes
  • Recent surgery or trauma or surgery to treat cancer of the mouth, throat or neck
  • Inadequate oral care
  • Increasing age
  • Poor functional status
  • Dementia
  • Co-morbid conditions
  • Male gender
  • Swallowing difficulty
  • Inability to take oral medications
  • Medications such as anti-psychotics, anticholinergics, H2 receptor blockers and proton pump inhibitors

Preventing pneumonia

Several preventative measures can be taken to reduce risk. If a patient is considered high-risk because of their age or overall health, you may choose to do additional tests including CT scans of the chest, arterial blood gas test (more accurate than the simpler pulse oximetry), pleural fluid culture, bronchoscopy or biopsy.

In the pre-admission process:

  • Do you have a listing of services/capabilities to ensure your facility meets the specific acuity level of the patient or resident?
  • Are the hospital discharge instructions complete and include advance directives?
  • Does your facility have a process in place to ensure readiness for admissions?

In the post-admission process:

  • Are you doing quality rounding for at least the first seven days? Is upper management involved?
  • Are clinical staff up-to-date in their assessment skills and continuing education?
  • Are you using Situation, Background, Assessment, Recommendation (SBAR) or an equivalent system to ensure proper/informed communication?

In the discharge planning process:

  • Are you starting the discharge process upon admission? Is it interdisciplinary?
  • Are you properly discharging patients and residents with clear/concise instructions?
  • Is social services completing a post-discharge follow-up to ensure patient or resident well-being?

Diagnosing pneumonia

Sometimes pneumonia can be difficult to diagnose because the symptoms are so variable and are often very similar to those seen in a cold or influenza. To diagnose pneumonia, and to try to identify the pathogen that is causing the illness, the below steps may be considered:

  1. Medical history: Ask questions about signs and symptoms, and how and when they began. To help figure out if the infection is caused by bacteria, viruses or fungi, you may ask questions about possible exposures, such as travel, occupation, animal contact, exposure to other sick people or whether they recently had another illness
  2. Physical exam/Auscultation: Listen to lungs with a stethoscope. Rumbles, crackles or bubbling often indicate pneumonia, and absent breath sounds and/or wheezing may also be present.
  3. Diagnostic tests: If you suspect pneumonia, you might recommend some tests to confirm the diagnosis and learn more about the infection, which may include blood tests, chest X-rays, pulse oximetry or sputum test.

Treating pneumonia

  1. Incentive spirometry
    • Frequently used at the bedside and is single-patient use
    • If visible secretions are present on the mouthpiece or connecting tubing, they should be cleaned with soap and water, rinsed and air-dried
  2. Small-volume medication nebulizers, in-line and handheld
    • Clean, disinfect and rinse with sterile water between treatments
    • Allow to dry and store in a manner that prevents contamination
    • Use only sterile fluid and medication and dispense into the nebulizer aseptically
    • Use single-dose medication whenever possible
    • If multidose vials are used, follow manufacturer instructions for storage and use no more than 28 days from the date of opening or until the expiration date
  3. Oxygen humidifiers
    • Follow manufacturer instructions for use
    • Tubing, prongs and masks should be single-patient use and changed weekly if visibly contaminated or malfunctioning (or according to organization policy)
Pathway Health

Pathway Health

Pathway Health is a professional management and consulting organization serving clients in the long-term care and post-acute care space. Pathway Health keeps a pulse on clinical, regulatory, quality and reimbursement trends to help keep clients on the path to success.

PointClickCare eINTERACT™

PointClickCare eINTERACT™

PointClickCare provides eINTERACT quality improvement program paired with Electronic Health Record (EHR) software platforms to help reduce readmission rates and access timely quality improvement data.

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