Community Acquired Pneumonia

CLINICAL PATHWAY
 QEH/HH  PCH  KCMH  Souris
 Western  Stewart Memorial  O'Leary
PATIENT ID
INCLUSION CRITERIA

All patients who are admitted to hospital with community-acquired pneumonia.

EXCLUSION CRITERIA
• Patients under 18 years of age
• Immunocompromised patients
• Hospital acquired pneumonia (onset after 4 days of hospitalization)
• Aspiration pneumonia
• Patients with cystic fibrosis or tuberculosis
• Pregnant women

HOW TO USE THE CLINICAL PATHWAY

1. This is a proactive tool to avoid delays in treatment and discharge.
These are not orders, only a guide to usual orders.

2. Place the Clinical Pathway in the nurses clinical area of the chart. All
health care professionals should fill in the master signature sheet at
the front of the Pathway. Addressograph/sticker each page of the
Pathway.

3 HEALTH CARE PROFESSIONALS: Initial tasks as completed.

Bulleted and shaded sections do not need to be signed for on the
pathway, but are to serve as a remider for consideration and to be
completed as required. Additional tasks due to patient individuality
can be added to the pathway in “OTHER” boxes and/or Progress
Notes.

4 PATIENT TRANSFERS: If patient is transferred to another hospital in

PEI or to home care or long-term care facility, send a copy of the
following to the receiving site/agency:

Discharge Criteria - Original to stay on patient chart

Teaching Checklist - Original to stay on patient chart

Updated April 20, 2011 Adapted from Grey Bruce Health Network Review November 1, 2011
 NAME
INITIAL SIGNATURE POSITION
(Please Print)

Updated April 20, 2011 Adapted from Grey Bruce Health Network Review November 1, 2011
 Admitting Date / Time_________________________
COMMUNITY ACQUIRED
PNEUMONIA
CLINICAL PATHWAY
ACUTE STAGE
PATIENT ID
COMORBID CONDITIONS:

DATE DATE
PHASE 1 ____________ ____________
(Approximately 2 days)
PROCESS

evening

evening
night

night
day

day
ADMITTING DATE
Admission - Acute VITALS MET
IINITIAL

Normal mental status (or usual mental status if

chronically altered mental status) - oriented to time,
place, and person
Respiratory rate 30/min or less for 24 hours
PATIENT Once all Patient Outcomes are
OUTCOMES Temperature 36-38.5°C for 24 hours achieved,
move to Phase 2
Heart rate <120 BPM for 24 hours

Decreased dyspnea, cough, and sputum production

VS Q4h & PRN x 24H, including SpO 2

QID x 24h, including SpO2

ASSESSMENT Monitor intake / output
(OBSERVATIONS/
Chest assessment Q4H (breath sounds, productive cough)
MEASUREMENTS/
ELIMINATION)  Isolation: Modifed droplet/contact precautions (if necessary)
- Pneumococcal Yes No  Unknown
Research Immunization History
- Influenza Yes No  Unknown
Home Care if required Yes No
CONSULTS Physio consult if required Yes No
Discharge planning if required Yes No
Blood work as ordered Yes No
Blood culture x 2 if ordered Yes No
DIAGNOSTICS/ Sputum for C&S & gram stain if ordered Yes No
LABORATORY CXR, PA & Lateral Yes No
 ECG
 ECG with chest pain and notify physician

Updated April 20, 2011 Adapted from Grey Bruce Health Network Review November 1, 2011
 Community Acquired Pneumonia
PATIENT ID
DATE DATE
PHASE 1 ____________ ____________

PROCESS (Approximately 2 days)

evening

evening
night

night
day

day
ADMISSION - ACUTE

Intermittent set / IV as ordered

MEDICATIONS
Medication Reconciliation Yes No
TREATMENTS/ Oxygen to keep SPO2 >90 or as ordered
INTERVENTIONS Secreation clearance technique as indicated (Chest Physio) Yes No N/A
Incentive Spirometry Yes No N/A
 Assist personal hygiene
 Regular diet or special diet_______________________, encourage fluids
NUTRITION 2-3 litres/day
Up in chair
MOBILITY/ACTIVITY
Walk short distance

Review Patient Pathway

PSYCHOSOCIAL
SUPPORT/ Teaching Checklist
EDUCATION  Assess anxiety and intervene

Assess Discharge Criteria daily

 <4 day hospital stay

DISCHARGE  >70 years old

Assess for
PLANNING addt'l  Unstable secondary DX
supports:
 Social situation

 Medication compliance

Updated April 20, 2011 Adapted from Grey Bruce Health Network Review November 1, 2011
 COMMUNITY ACQUIRED PNEUMONIA
CLINICAL PATHWAY
ACUTE STAGE PATIENT ID

PHASE 2 DATE DATE DATE

___________ ___________ ___________
PROCESS (Approximately 3 days)

evening

evening

evening
night

night

night
day

day

day
DATE
INITIAL
MET

Off supplemental oxygen or on

usual O2 if on chronic home
oxygen
Once all Patient Outcomes are achieved,
PATIENT OUTCOMES Temperature <38°C for 24hours
move to Discharge Criteria
or greater

Understands diagnosis and

discharge plan

VS BID once stable, including SpO 2

ASSESSMENT Chest assessment (breath sounds, productive
(OBSERVATIONS/ cough)
MEASUREMENTS/  Isolation; modified droplet/contact precautions
(if necessary)
ELIMINATION)
 Monitor intake / output

CONSULTS  Home O2 therapy as needed

CXR if patient is not improving Yes No N/A

DIAGNOSTICS/  ABG's if ordered
LABORATORY  Thoracentesis if ordered
 Blood work as ordered

MEDICATIONS  Intermittent set/ IV as ordered

O2 if indicated
TREATMENTS/ Secreation Clearance techniques as indicated
(Chest Physio) Yes No N/A
INTERVENTIONS
Incentive Spirometry Yes No N/A
 Regular diet, or special diet ____________
NUTRITION encourage fluids 2-3 litres/day

Up in Chair
MOBILITY/ACTIVITY
Activity as tolerated - increase activity level

Review Patient Pathway

PSYCHOSOCIAL  Continue Teaching Checklist
SUPPORT/
 Review handouts
EDUCATION
 Assess patient knowledge

DISCHARGE Assess Discharge Criteria daily

PLANNING Review Discharge Plans with patient Yes No N/A

Updated April 20, 2011 Adapted from Grey Bruce Health Network Review November 1, 2011
COMMUNITY ACQUIRED PNEUMONIA
CLINICAL PATHWAY
ACUTE STAGE
PATIENT ID

PROCESS DISCHARGE CRITERIA DATE INITIAL N/A

Temp <38°C
ASSESSMENT
(OBSERVATIONS/ Resp <24/min

MEASUREMENTS/ Pulse <100 BPM

ELIMINATION) SpO2 >90% or as ordered

CONSULTS

DIAGNOSTICS/ WBC <12x109 /L

LABORATORY Stable comorbid illness

MEDICATIONS Discharge medication list reviewed and copy to patient

TREATMENTS/
INTERVENTIONS
NUTRITION Tolerating regular diet

MOBILITY/ACTIVITY Activity as tolerated

PSYCHOSOCIAL Handouts and Patient Pathway home with patient

SUPPORT/
EDUCATION Patient questions answered

DISCHARGE
Home Care if necessary
PLANNING

Updated April 20, 2011 Adapted from Grey Bruce Health Network Review November 1, 2011