Deviation in the Standard of Postoperative Care Resulting in Pneumonia

Evaluate breaches in the standard of care by using your fact pattern to carefully and accurately answer the questions below to determine whether or not there was or was not a Deviation in the Standard of Postoperative Care Resulting in Pneumonia

Answer the following questions to find out if the standard of care was followed for your case.

  • Did the patient require intubation and mechanical ventilation post-operatively?
    Yes
    No
    Why is this important?
    The risk of developing nosocomial pneumonia is increased 4 to 21 fold for intubated patients and increases with the duration of assisted ventilation.
    (2001) 85 EMEDCN 6 1545-1563

  • Were pain medications administered? Why is this important?
    Answer this question
    
Treatment of post-operative pain is important in the prevention of atelectasis.

    (2010) 24 EBPRCA 2 145-155 



  • Was the patient’s respiratory status assessed and documented? Why is this important?
    Answer this question
    
Respiratory status must be assessed frequently, including the assessment of lung sounds (auscultation), chest excursion and presence of an adequate cough.

    (2010) 24 EBPRCA 2 145-155 



  • Were the patient’s vital signs monitored? Why is this important?
    Answer this question
    
Clinical observations must be supplemented by frequent assessment of the patient’s vital signs.

    (2009) 10 EAICMD 12 576-579 



  • Was the patient’s blood sugar monitored? Why is this important?
    Answer this question
    
Hyperglycemia has been identified as an independent risk factor for postoperative infection. The target glucose level for postoperative patients is 80-110mg/dL.

    (2008) 22 EBPRCA 3 519-535 



  • Were incentive spirometry and breathing exercises ordered for the patient? Why is this important?
    Answer this question
    
The prevention of post-operative pulmonary complications is based on prevention of atelectasis by deep breathing, sitting up, effective pain relief, and early mobilization.

    (2010) 24 EBPRCA 2 145-155 



  • Was the patient mobilized as soon as possible after surgery? Why is this important?
    Answer this question
    
Lung expansion is improved with mobilization.

    (1997) 185 JNLACS 6 584-592 



  • Which of the following were performed to diagnose the patient’s pneumonia? (Choose all that apply) Why is this important?
    Answer this question
    
All patients with suspected nosocomial pneumonia must have a diagnostic evaluation.

    (1998) 14 ECRICC 1 119-133 



  • Was the patient started on antibiotics? Why is this important?
    Answer this question
    
All patients with suspected nosocomial pneumonia must have a diagnostic evaluation. Nosocomial pneumonias are common and are a frequent cause of mortality and morbidity in patients in intensive care units. Appropriate antibiotic therapy is based upon the infecting organism.

    (2001) 85 EMEDCN 1 79-114 



  • Were discharge instructions provided to the patient? Why is this important?
    Answer this question
    
Patients must receive thorough discharge instructions reflecting the treatment they have received, the new medications they have been prescribed, and the necessary follow up evaluations required after discharge to minimize the likelihood of relapse and re-admission to the healthcare facility.

    (2009) 89 ESRCNA 2 439-461 



  • Was frequent suctioning of secretions performed and documented? Why is this important?
    Answer this question
    
Leakage around the endotracheal tube cuff enables pooled secretions and bacteria to enter the trachea, leading to pneumonia.

    (2001) 85 EMEDCN 6 1545-1563 



  • Was the patient maintained in a semi-fowlers position as documented in the medical record? Why is this important?
    Answer this question
    
In mechanically ventilated patients, a semi-recumbent body position may reduce the incidence of ventilator associated pneumonia (VAP) significantly.

    (2001) 85 EMEDCN 6 1545-1563 



  • Did the patient receive tube feedings? Why is this important?
    Answer this question
    
In mechanically ventilated patients, to minimize further the risk of nosocomial pneumonia (NP) associated with enteral tube placement and feeding, an orogastric tube is recommended over nasogastric intubation to reduce sinusitis and possibly pneumonia.

    (2001) 85 EMEDCN 6 1545-1563 



  • Were medications administered for stress bleeding prophylaxis? Why is this important?
    Answer this question
    
Antacids and H2 blockers are administered for prevention of stress bleeding in critically ill patients.

    (2001) 85 EMEDCN 6 1545-1563 



  • Were bowel sounds monitored frequently? Why is this important?
    Answer this question
    
The administration of enteral feedings may predispose to pneumonia by causing gastric distention, increasing the risk of reflux and aspiration.

    (2001) 85 EMEDCN 6 1545-1563 



  • Were aseptic precautions utilized and documented during suctioning of the endotracheal tube? Why is this important?
    Answer this question
    
Tracheal suction catheters may inoculate bacteria directly into the respiratory tract, and aseptic technique, including gloves, is necessary to minimize direct exposure to the patient.

    (2001) 85 EMEDCN 6 1545-1563 



  • Was all equipment sterilized between uses? Why is this important?
    Answer this question
    
Cleaning, disinfecting and sterilization of all reusable respiratory therapy equipment are essential to reduce the nosocomial transmission of infectious agents.

    (2001) 85 EMEDCN 6 1545-1563 



  • Was the patient weaned from mechanical ventilation and extubated as early as possible? Why is this important?
    Answer this question
    
Mechanical ventilation (MV) is the major life-support modality during respiratory failure. Once the illness that precipitated respiratory failure has resolved, MV can be discontinued.

    (1998) 14 ECRICC 4 799-817