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["Baseline assessment: Pneumonia in adults:"]
["diagnosis and management"]
["CG191"]
[]
[]
["Published: December 2014"]
["Updated: 31 October 2023"]

{"sheet":"Introduction","index":1,"n_rows":23,"n_cols":1,"rows_kept":23,"cut":false,"hidden":false,"merged":[]}
["Baseline assessment tool for Pneumonia in adults: diagnosis and management (NICE guideline CG191)"]
[]
["This baseline assessment tool can be used to evaluate whether practice is in line with the recommendations in Pneumonia in adults: diagnosis and management.  It can also help to plan activity to meet the recommendations."]
[]
["The tool can be used by individual services or organisations. Alternatively, an assessment completed with the involvement of all relevant services or organisations would help to develop a picture of activity in the local area."]
[]
["It should be used in conjunction with pneumonia in adults (NICE guideline CG191)."]
[]
["In the first instance, consider whether the guideline is relevant and record the conclusion in the box below."]
[]
["Is the guideline relevant?"]
[]
[]
["The data sheet contains the recommendations from the guideline. Information can be entered about current activity relevant to the recommendation, actions needed to meet the recommendation, deadlines and the names of the responsible leads.  Useful documents can be added as hyperlinks."]
[]
["The table can be adapted to include any other local information that is thought to be useful."]
[]
["If it would be helpful to group the recommendations, for example those that are key priorities for implementation or by deadline, use the filter function in the data menu. "]
[]
["Tools and resources to help put the guidance into practice are available on the NICE website. "]
[]
[]
["National Institute for Health and Care Excellence\nLevel 1A, City Tower, Piccadilly Plaza, Manchester M1 4BT; www.nice.org.uk\n\nCopyright\n© NICE 2023. All rights reserved. Subject to Notice of rights.\n"]

{"sheet":"Data sheet","index":2,"n_rows":48,"n_cols":11,"rows_kept":48,"cut":false,"hidden":false,"merged":[[0,0,0,10]]}
["Baseline assessment tool for Pneumonia in adults: diagnosis and management (NICE guideline CG191)"]
[]
[null,null,null,null,"Number of relevant recommendations",{"$f":"COUNTIF(D8:D48,\"Yes\")","v":0}]
[null,null,null,null,"Number of recommendations met",{"$f":"COUNTIF(F8:F48,\"Yes\")","v":0}]
[null,null,null,null,"Percentage of recommendations met",{"$f":"IF(ISERROR(F4/F3),\"\",F4/F3)","v":""}]
[]
["NICE recommendation","Guideline reference","Year of recommendation","Is the recommendation relevant?","Current activity/evidence","Recommendation met?","Actions needed to implement recommendation","Is there a risk associated with not implementing this recommendation?","Is there a cost or saving?","Deadline","Lead"]
["1.1 Presentation with lower respiratory tract infection"]
["For people presenting with lower respiratory tract infection, see NICE’s guideline on suspected acute respiratory infection in over 16s.","1.1.1","2014, amended 2023"]
["1.2 Community-acquired pneumonia "]
["Severity assessment outside hospital"]
["If a clinical diagnosis of community-acquired pneumonia has been made, carry out a risk assessment using the CRB65 scoring systeme (see box 1). ","1.2.1","2014, amended 2023"]
["Use clinical judgement together with the CRB65 score (bearing in mind this can be affected by other factors, for example, co-morbidities or pregnancy) to inform decisions about whether people with a clinical diagnosis of community-acquired pneumonia   need hospital assessment as follows:\n•\tconsider hospital assessment for people with a CRB65 score of 2 or more\n•\tdiscuss the options with people with a score of 1 and make a shared decision about the best care pathways for them, for example supported home-based care using a virtual ward or community intervention team\n•\tconsider home based care for patients with a CRB65 score of 0.","1.2.2",2014]
["Severity assessment in hospital"]
["When a diagnosis of community-acquired pneumonia is made at presentation to hospital, determine whether people are at low, intermediate or high risk of death using the CURB65 score (see box 2).","1.2.3",2014]
["Use clinical judgement in conjunction with the CURB65 score to guide the management of community-acquired pneumonia, as follows:\n• consider home-based care for people with a CURB65 score of 0 or 1\n• consider hospital-based care for people with a CURB65 score of 2 or more\n• consider intensive care assessment for people with a CURB65 score of 3 or more.\n","1.2.4",2014]
["Stratify people presenting with community-acquired pneumonia into those with low-, moderate- or high-severity disease. The grade of severity will usually correspond to the risk of death.","1.2.5",2014]
["Microbiological tests"]
["Do not routinely offer microbiological tests to people with low-severity community-acquired pneumonia.","1.2.6",2014]
["For patients with moderate- or high-severity community-acquired pneumonia:\n• take blood and sputum cultures and\n• consider pneumococcal and legionella urinary antigen tests.\n","1.2.7",2014]
["Timely diagnosis and treatment"]
["Put in place processes to allow diagnosis (including X-rays) and treatment of community-acquired pneumonia within 4 hours of presentation to hospital.","1.2.8",2014]
["Antibiotic therapy"]
["See NICE’s guideline on pneumonia (community-acquired): antimicrobial prescribing for recommendations on antibiotic therapy."]
["Deleted","1.2.9"]
["Deleted","1.2.10"]
["Deleted","1.2.11"]
["Deleted","1.2.12"]
["Deleted","1.2.13"]
["Moderate- and high-severity community-acquired pneumonia"]
["Deleted","1.2.14"]
["Deleted","1.2.15"]
["Deleted","1.2.16"]
["Glucocorticoid treatment"]
["Do not routinely offer a glucocorticoid to people with community‑acquired pneumonia unless they have other conditions for which glucocorticoid treatment is indicated.","1.2.17",2014]
["Monitoring in hospital"]
["Consider measuring a baseline C-reactive protein concentration in people with community-acquired pneumonia on admission to hospital, and repeat the test if clinical progress is uncertain after 48 to 72 hours.","1.2.18",2014]
["Safe discharge from hospital"]
["Do not routinely discharge people with community-acquired pneumonia if in the past 24 hours they have had 2 or more of the following findings:\n• temperature higher than 37.5°C\n• respiratory rate 24 breaths per minute or more\n• heart rate over 100 beats per minute\n• systolic blood pressure 90 mmHg or less\n• oxygen saturation under 90% on room air\n• abnormal mental status\n• inability to eat without assistance.","1.2.19",2014]
["Consider delaying discharge for people with community-acquired pneumonia if their temperature is higher than 37.5°C.","1.2.20",2014]
["Patient information"]
["Explain to people with community-acquired pneumonia that after starting treatment their symptoms should steadily improve, although the rate of improvement will vary with the severity of the pneumonia, and most people can expect that by:\n• 1 week: fever should have resolved\n• 4 weeks: chest pain and sputum production should have substantially reduced\n• 6 weeks: cough and breathlessness should have substantially reduced \n• 3 months: most symptoms should have resolved but fatigue may still be present \n• 6 months: most people will feel back to normal. ","1.2.21",2014]
["Advise people with community-acquired pneumonia to consult their healthcare professional if they feel that their condition is deteriorating or not improving as expected.","1.2.22",2014]
["1.3 Hospital-acquired pneumonia"]
["Antibiotic therapy"]
["Deleted","1.3.1"]
["Deleted","1.3.2"]
["Deleted","1.3.3"]

{"sheet":"Box 1","index":3,"n_rows":2,"n_cols":1,"rows_kept":2,"cut":false,"hidden":false,"merged":[]}
["Box 1 CRB65 score for mortality risk assessment in primary care"]
["CRB65 score is calculated by giving 1 point for each of the following prognostic features:\n\n•\tconfusion (abbreviated Mental Test score 8 or less, or new disorientation in person, place or time). For guidance on delirium, see NICE’s guideline on delirium.\n•\traised respiratory rate (30 breaths per minute or more)\n•\tlow blood pressure (diastolic 60 mmHg or less, or systolic less than 90 mmHg)\n•\tage 65 years or more.\n\nLim WS, van der Eerden MM, Laing R, et al. (2003) Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 58: 377–82\n\nPeople are stratified for risk of death (within 30 days) as follows: \n\n•\t0: low risk (less than 1% mortality risk)\n•\t1 or 2: intermediate risk (1 to 10%   mortality risk)\n•\t3 or 4: high risk (more than 10% mortality risk)."]

{"sheet":"Box 2","index":4,"n_rows":2,"n_cols":1,"rows_kept":2,"cut":false,"hidden":false,"merged":[]}
["Box 2 CURB65 score for mortality risk assessment in hospital"]
["CURB65 score is calculated by giving 1 point for each of the following prognostic features:\n\n•\tconfusion (abbreviated Mental Test score 8 or less, or new disorientation in person, place or time). For guidance on delirium, see NICE’s guideline on delirium\n•\traised blood urea nitrogen (over 7 mmol/litre)\n•\traised respiratory rate (30 breaths per minute or more)\n•\tlow blood pressure (diastolic 60 mmHg or less, or systolic less than 90 mmHg)\n•\tage 65 years or more.\n\nPeople are stratified for risk of death as follows: \n\n•\t0 or 1: low risk (less than 3% mortality risk)\n•\t2: intermediate risk (3 15% mortality risk)\n•\t3 to 5: high risk (more than 15% mortality risk).\n\nLim WS, van der Eerden MM, Laing R, et al. (2003) Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 58: 377–82"]