This is the current release of the guideline.

Recommendations for the evaluation of care provided to the immunocompetent adult patient with community-acquired pneumonia (CAP) who is being treated at home or in an unskilled residential facility are summarized below. Future research should be focused on evidence for appropriate assessment and in-home treatment, such as diagnostic tests, home care interventions, and the exploration of the efficacy of telephone triage in selected groups of patients who are at low risk and are well-known to the provider. Finally, the approach to the in-home management of CAP that has been outlined herein, and others, should be studied to assess their impact on patient outcomes (especially in the elderly) and to ensure that in-home management can achieve the same level of quality and patient outcomes as at any other treatment site for appropriate patient subsets.

Recommendations for the Home Treatment of Patients with CAP

Initial Patient Evaluation and Diagnosis in the Home Environment

1. A qualified provider includes a physician, nurse practitioner, or physician assistant.
2. The initial evaluation should be performed in person by a qualified provider or by a visiting home nurse who is in contact with a qualified provider at the time of the evaluation. In this case, the qualified provider must evaluate the patient within 24 hours of the initial diagnosis. Telephone triage alone is not acceptable.
3. If a qualified provider does not meet with the patient at the time of the initial evaluation, the provider must see the patient sometime between presentation and closure.

Determination of Site of Care

4. Home care should be an option if it can provide the same level of quality and achieve the same level of recovery and functional status, consistent with the patient's wishes and overall treatment goals, as would be possible at any other site of care.
5. Care should be provided in a timely fashion. If these goals cannot be achieved in the home care setting, transfer to an acute care facility should be considered.
   • The first dose of antibiotic should be administered within 8 hours of presentation.
   • Oxygenation should be optimized within 8 hours of presentation.
   • Hydration should be initiated within 8 hours of presentation.
6. If a patient care contract cannot be agreed to or is violated, transfer to an acute care facility should occur.

Management of CAP at Home

7. The patient should be treated with antibiotics based using the empiric therapy guidelines of the American Thoracic Society (ATS) and Infectious Disease Society of America (IDSA).

Monitoring and Goals for Nurses Providing Interim Home Care

8. Repeat assessment should be performed within 24 hours for the high-risk patient.
9. If a provider chooses not to refer a patient to a home care agency, the standards for interim care must still be met.

Closure

10. There should be a closure visit for each patient during which the risk of recurrence is evaluated, preventive measures are discussed, and functional status is assessed.
11. A chest radiograph should be obtained to confirm the resolution of the illness a minimum of 8 weeks following diagnosis.

None provided

The type of evidence supporting the recommendations is not specifically stated. The recommendations are based on a review of the guideline literature and on a consensus panel meeting of the American Academy of Home Care Physicians (AAHCP) Community-Acquired Pneumonia Working Group.

Not applicable: The guideline was not adapted from another source.

2005 May

American Academy of Home Care Physicians - Professional Association
American College of Chest Physicians - Medical Specialty Society

American College of Chest Physicians

American College of Chest Physicians' Home Care Network Working Group

Primary Authors: Joe Ramsdell, MD, FCCP, Department of Medicine, University of California, San Diego, Medical Center, San Diego, CA; Georgia L. Narsavage, PhD, RN, CS, Francis Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH; James B. Fink, MS, RRT, Aerogen

Work Group Members: Joe Ramsdell, MD, FCCP; Ann Cathcart, MSW, RSW; Georgia L. Narsavage, PhD, RN, CS; Nicholas S. Hill, MD, FCCP; James B. Fink, MS, RRT; Joe Lewarski, RRT; Barry Make, MD, FCCP

It is essential that the American College of Chest Physicians (ACCP) have full disclosure of outside interests from those individuals serving on policy development committees, including liaison representatives from outside organizations. Both real and potential conflicts of interest may actually affect impartial or objective decisions or may appear to.

No conflicts are reported in the original consensus document.

This is the current release of the guideline.

None available

None available

This NGC summary was completed by ECRI on July 26, 2005. The information was verified by the guideline developer on July 26, 2005.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.