Decreasing Pulmonary Complications with I COUGH

Coughing is often a symptom of illness. But for patients who cough post-surgery, it can be a sign of something good: the prevention of pneumonia.

Deep coughing is encouraged post-surgery to expand the lungs and help prevent pneumonia and other breathing difficulties patients may face after surgery. Last August, Boston Medical Center surgeons and nurses developed a new program, called I COUGH, which aims to reduce the number of cases of post-operative pneumonia and minimize the amount of time patients stay on ventilators after operations. The program’s goal is to decrease the number of post-operative pulmonary complications by at least 50 percent hospital-wide, and is one of several Quality and Patient Safety initiatives focused on improving the safety and quality of patient care.   

 

I COUGH stands for:
Incentive spirometry (usage of a simple device that encourages deep breathing to inflate the lungs after an operation),
Coughing and deep breathing,
Oral care,
Understanding (patient education),
Getting out of bed, and
Head of bed elevation.

All patients who undergo major operations, particularly those under general anesthesia, perform these activities post-surgery, and regular practice of them should improve pulmonary outcomes, says BMC surgical oncologist David McAneny, MD.

“Early results indicate steady improvement in care,” says McAneny, the Department of Surgery’s Vice Chair for Quality and Patient Safety, who is spearheading the initiative, along with nurse Karen Weinstock, BSN.

The program starts with education. Prior to admission, patients receive brochures and view a video on the importance of participating in I COUGH. They also are given instructions on how to use the incentive spirometer. Post-surgery, BMC nurses care for patients based on pulmonary care orders they receive electronically from surgeons. This helps guide the standardized care of patients.

McAneny says the program’s success is predicated upon patients and their families understanding, anticipating and appreciating high standards of care, including early post-operative mobilization.

“It is essential to educate both patients and staff to modify longstanding practices in order to reduce the incidence of pulmonary complications,” says McAneny, “and the results underscore the critical roles of surgeons and nurse managers in leading culture change.”

Results of the first year of the program are expected in early fall. 

 

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