Improving Documentation and Education of Pneumonia Patients to Reduce Readmissions

1. Improving Documentation and Education of Pneumonia Patients to Reduce Readmissions Name Jennifer S. Wilson

2. Description of issue • Pneumonia patients are listed as high risk for readmissions within 30 days of discharge. • Pneumonia patient’s have a 17.9% readmission rate.(The Common Wealth Fund, 2012) • As of Oct. 2012 new Medicare penalties will take effect. The new law directs Medicare to recover payments made for unnecessary readmissions within 30 days of discharge after a stay for three conditions: heart attack, CHF and pneumonia. (US News and World Report, 2012).

3. Description of issue, cont. • All patient’s discharged from hospital with diagnosis of pneumonia will have home care ordered. • Home care will follow patient after discharge and make sure patient is compliant with physician orders, keeps all follow up MD appointments, and is educated on s/s to report to MD.

4. Technological Innovation • Develop a computer pathway specifically for pneumonia patient’s • Pathway will have relevant information related to patient’s admitted to home care services with diagnosis of pneumonia • Pathway to include: respiratory assessment (breath sounds, cough, respiratory status, dyspnea) • Interventions(teaching to be done) in pathway: s/s to report to MD, nebulizers, inhalers, breathing exercises, pulse oximetry, causes

5. Technological Innovation, cont. • Interventions(teaching to be done) in pathway: breathing exercises, pulse oximetry, causes of pneumonia, risk factors.

6. Work flow Diagram--before Documentation on pneumonia Patient before New technology Regular SNV Admission f/u visit, documentationdone in home Visit documentation done in home Visit done in home using standard pathway. WMHS assess standard pathway used.

7. Work flow Diagram--before, cont. Follow up visit doc. done after visit Visit completed in home Additional information added to pathway related to pneumonia Education handouts handwritten by nurse during visit Added time necessary to include information related to diagnosis of pneumonia. Visit data available as soon as exported. But extra time needed to add information and writing up education papers for patient.

8. Work flow Diagram--after Computer documentation on Pneumonia patient after added technology Regular SNV Admission visit Follow up visit made, doc. Done in home SOC visit made, all computer doc. Done in home

9. Work flow Diagram--after Pathway used, Documentation in home All information r/t diagnosis in pathway. All nurse has to do is add pathway. Pathway with specific information related to pneumonia used. Pre-printed education handouts used. Charting done using pathway. Documentation completed, information exported. Patient exported All nurses teaching same information. More efficient documentation needed information is not missed. Visit data avail. As soon as patient exported. Use of pathway and pre-printed education sheets cuts down on documentation time and provides more efficient education to patients.

10. Timeline for Change • Program should take three-four months to implement. • Information sent to IT so items can be added to PTcT • Education of staff • Education handouts made, printed and put together • Total cost: $1,200.

11. Change Theory-Lewin’s Theory of Change • Unfreezing: the process of finding a method of making it possible to let go of an old pattern that was counterproductive. • Old method of entering assessments and interventions into pathway is time consuming and different nurses add/omit different information. • Handwritten education sheets are time consuming and patients are not always able to read nurses handwriting. No continuity of information taught.

12. Change Theory, cont. • Move: Moving to a new level or changing “movement”. Involves the process of changes in thoughts, feelings, behavior or all three that is more productive in some way. • Implementation of new pathway and education materials for patients. • Refreezing: Establishing change as new habit so it now becomes “standard operating procedure”. Necessary step so people do not fall back to old habits or behaviors.(Nursing Theories, 2011). • After inservice on changes, staff to use new pathway and education materials on all pneumonia patients.

13. References Carrns, A.(2010, July 21). Health Reform Takes Aim at Hospital Readmission Rates. US News and World Report. Retrieved from http://health.usnews.com/health-news/best- hospitals/articles Chen, L. Jha, A., Guterman, A. Ridgway, A., Orav, J., & Epstein, A.(2010). Hospital Cost of Care, Quality of Care, and Readmission Rates: Penny-Wise and Pound-Foolish(The Commonwealth Fund)[Supplemental material]. Archives of Internal Medicine, 170(4), 340-346.

14. References, cont. Retrieved from http://www.commonwealthfund.org/Publication/I n-the-Literal-Cost-of-Care-Quality-of-Care-and- Readmission-Rates.aspx. Change Theory, Kurt Lewin.(2011). Nursing Theories. Retrieved from currentnursing@gmail.com