Simplifying treatment of community acquired pneumonia using an "Eggs and Toast" approach

Purpose:
Multidisciplinary teams providing care for patients with community acquired pneumonia sought to improve performance, care, and outcomes for patients diagnosed with pneumonia. The “Eggs and Toast” tool simplifies the complex prescribing criteria leading to sub-standard care scores.

Significance:
Complying with CMS core measures criteria contributes to hospital reimbursement and follows best-practice standards for patient care under a pay-for-performance economy. Nurses empowered to contribute knowledge and insight toward patient care decisions will experience heightened job satisfaction.

Strategy and Implementation:
The strategy to improve compliance with community acquired pneumonia care addressed two primary concerns: blood culture collection and antibiotic selection. Although both of these elements are ordered by physicians, nurses play a significant role in validating appropriate care as critical thinkers on the patient care team. Empowering nurses to question practice and suggest therapies contributed to a strong team-approach for care and improved communication between nurses and physicians. Understanding the appropriate combination of medications required by this core measure requires a depth of understanding expected from physicians and pharmacists. To facilitate nursing confidence and understanding – and to increase physician compliance with the medication criteria – the combinations of appropriate medications were divided into two categories associated with either Eggs or Toast. An illustrated diagram prompts selection of one “Eggs” medication and one “Toast.”

Evaluation:
Before implementing the “Eggs and Toast” tool, only 44% of patients with CAP received optimal care according to TJC guidelines. Initial efforts raised scores to 86%. Implementating this tool delivered immediate score improvement reaching and sustaining 97% to 100% for CAP care compliance.

Implications for Practice:
The “Eggs and Toast” tool verifies appropriate antibiotic selection and enables nurses to validate optimal antibiotic selection for patients with community acquired pneumonia. Simplifying the criteria increased compliance with the core measure and contributes to the team-approach of patient care.