OASIS Alert

Published on Thu Feb 04, 2010 PDF

Here are three easy ways to keep your patients healthy.

OASIS C's focus on processes and preventive care should help you reduce the potentially lethal risk of pneumonia in your home care patients. By targeting the following assessment areas, you'll save your patients' health while also vastly improving their outcomes.

In its quest to avoid costly hospital stays, the Centers for Medicare & Medicaid Services has included pneumococcal pneumonia vaccination as one of the process measures in the new  OASIS C assessment. M1050 asks if the patient received the pneumococcal polysaccharide vaccine (PPV) from your agency during the episode of care. The current vaccine covers 23 of the more than 80 different types of pneumococcus bacteria. These 23 cause the vast majority of infections, experts say.

M1055 asks for a reason if your agency did not provide the vaccine. Agencies could have appropriate reasons for situations when this would be the case, says OASIS Expert JudyAdams with Adams Home Care Consulting in Chapel Hill, NC. The patient may have already had the PPV, may not have wanted it, or may have had contraindications.

Why it matters: Pneumococcal pneumonia can infect the upper respiratory tract and can spread to the blood, lungs, middle ear, or nervous system. It mainly causes illness in those younger than two and older than 65, according to the Institute for Healthcare Improvement. Elderly patients are at especially high risk of serious illness and death from this illness.

The CDC recommends the PPV for all adults 65 years and older, as well as for younger patients who have a variety of health problems. Usually only one vaccination is necessary, but a patient who received the PPV before the age of 65 should receive a second dose after 65, as long as five years have elapsed since the previous dose.

Don't overlook: Because the PPV is not administered again every year, patients and staff may have a harder time keeping track of this vaccine than they do with the flu vaccine, experts say.

Two other important areas to assess for pneumonia prevention are oral hygiene and mobility issues:

• Improve oral hygiene. "One of the major causes of pneumonia is aspiration which relates to problems with swallowing -- and there's a link between poor oral health and pneumonia," says Susan Levy, MD, a geriatric specialist in Baltimore, Md. One recent study showed a significantly decreased risk of pneumonia mortality in elderly patients who had assistance with oral hygiene, even after adjusting for all the other risk factors.

Consider therapy referral: Besides providing therapy for swallowing difficulties, occupational therapy or restorative nursing can help someone improve oral health, advises Elisa Bovee, an occupational therapist and director of education and training for Harmony Healthcare International in Topsfield, Mass. For example, gum flossers available today allow a patient to hold a plastic handle with a small piece of floss suspended in between, she notes. You can also add Thera Putty to a toothbrush handle to improve grip. Once a patient learns to use these simple devices, the caregiver can supervise the person's oral health care, rather than doing it for them, Bovee says.

• Address mobility issues. Improving a patient's mobility can help prevent pressure ulcers, improve muscle tone and circulation, and decrease incontinence. It can also help prevent pneumonia, says Patricia Boyer, MSM, RN, NHA, president of Boyer & Associates in Brookfield, Wis.

When you're assessing a patient who spends most of the time in bed, ask why, Boyer says. Make a therapy referral if needed. And if a temporary situation, such as orthopedic surgery,means a patient has to stay in bed, be sure to include turning or repositioning, coughing and deep breathing, and adequate hydration in the plan of care, she says. All of these are important in preventing pneumonia.