Pneumonia (PN) - CMS Core Measures
Pneumonia. Review of CMS core measures for inpatients with diagnosis of Pneumonia
including measures for patients admitted thru the Emergency Department.
Inpatient Pneumonia
If the initial clinical picture of the patient is questionable for pneumonia resulting in a delay in
the diagnosis, a clarifying statement is required ie. (“Diagnostic picture was questionable and
not suggestive of pneumonia and resulted in a delay in the diagnosis”.)
• PN -2 PNEUMOCOCCAL VACCINATION
• PN-3a BLOOD CULTURE ON ARRIVAL FOR ICU PATIENT - If ICU care is required
within 24hrs, a blood culture is required.
• PN-3b BLOOD CULTURE (if done in ED) drawn prior to the initial antibiotic
• PN-4 SMOKING CESSATION COUNSELING
• PN-5c INITIAL ANTIBIOTIC WITHIN 6 HOURS OF ARRIVAL
• PN-6 APPROPRIATE ANTIBIOTICS – for Non-ICU patients, ICU patients, and Non-ICU
patients with Pseudomonal Risk
*List of appropriate antibiotics
Addendum PN
Pneumonia Antibiotic Consensus Recommendations Oct 2010
Patient Type
Antibiotic Recommendation
Non – ICU Patient B-lactam (IV or IM) + Macrolide (IV or PO)
Or
Antipneumococcal Quinolone monotherapy (IV or PO)
Or
B-lactam (IV or IM) + Doxycycline (IV or PO)
Or
If less than 65 with no Risk Factors for Drug-Resistant Pneumococcus
Macrolide monotherapy (IV or PO)
B-lactam = Ceftriaxone, Cefotaxime, Ampicillin/Sulbactam, Ertapenem
Macrolide = Erythromycin, Clarithromycin, Azithromycin
Antipneumococcal Quinolones = Levofloxacin1, Moxifloxacin,
Gemifloxacin
Macrolide (IV) + either B-lactam (IV) OR
Antipneumococcal/Antipseudomonal
B-lactam (IV)
Or
Antipneumococcal Quinolone (IV)
OR Antipseudomonal Quinolone (IV) + either B-lactam (IV) OR
Antipneumococcal/ Antipseudomonal B-lactam (IV)
Or
Antipneumococcal/ Antipseudomonal B-lactam (IV) +
Aminoglycoside (IV) + either Antipneumococcal Quinolone (IV) Or
Macrolide (IV)
B-lactam = Ceftriaxone, Cefotaxime, Ampicillin/Sulbactam,
Antipneumococcal/ Antipseudomonal B-lactam = Cefepime, Imipenem,
Meropenem, Piperacillin/Tazobactam, Doripenem
Macrolide = Erythromycin, Azithromycin
Antipneumococcal Quinolones = Levofloxacin1, Moxifloxacin
Antipseudomonal Quinolone = Ciprofloxacin, Levofloxacin1
Aminoglycoside = Gentamicin, Tobramycin, AmiAmikacin
These antibiotics are acceptable for Non-ICU patients with Pseudomonal
Non-ICU patient
with Pseudomonal Risk ONLY:
Antipneumococcal/Antipseudomonal B-lactam (IV) +
Risk
Antipseudomonal Quinolone (IV or PO)
Or
Antipseudomonal B-lactam (IV) +
Aminoglycoside (IV) + either
Antipneumococcal Quinolone (IV or PO) Or Macrolide (IV or PO)
These antibiotics are ONLY acceptable for Non-ICU patients with Blactam allergy and Pseudomonal Risk:
Aztreonam (IV or IM) + Antipneumococcal Quinolone (IV or PO) +
Aminoglycoside (IV)
Or
Aztreonam2 (IV or IM) + Levofloxacin1 (IV or PO)
Antipseudomonal Quinolone = Ciprofloxacin, Levofloxacin1
Antipseudomonal B-lactam = Cefepime, Imipenem, Meropenem,
Piperacillin/Tazobactam, Doripenem
Aminoglycoside = Gentamicin, Tobramycin, Amikacin Macrolide =
Erythromycin, Clarithromycin, Azithromycin
Antipneumococcal Quinolone = Levofloxacin1, Moxifloxacin,
Gemifloxacin
ICU Patient
Specifications Manual for National Hospital Inpatient Quality Measures
Discharges 10-01-10 (4Q10) through 03-31-11 (1Q11) PN-6, 6ab-8
• PN-7 INFLUENZA VACCINATION
Reduce Variation in Pneumonia care practices and resource utilization. To improve
length of stay, provide the safest care by reducing unecessary imaging, and reduce unnecessary
delays in care of hospitalized pneumonia patients, this initiative has two parts:
1) Increase the percent of pneumonia patients that are converted from IV to oral antibiotics by
day 4 of their stay. An automatic conversion protocol is built into the established pneumonia
related antibiotic order set available thru Cerner/CPOE
2) Reduce the percent of pneumonia patients that receive a Chest CT as part of the routine
work-up (Chest CT to be ordered only for underlying disease or if complications are present)
Additional Tip:
 “Comfort care” patients are excluded from all HF measures and most AMI and PN measures.
Comfort care is not the same as DNR / DNI. You must specifically document “comfort care”
or hospice.
(2011)