Decreasing Hospital Admissions: Developing and Implementing a Cellulitis Pathway

Tuesday, 13 July 2010

Holly Kirkland-Walsh, RN, FNP, MSN
Wound Care NP, University of California at Davis, Sacramento, CA

Learning Objective 1: The learner will be able to name the exclusion criteria for an outpatient cellulitis treatment plan.

Learning Objective 2: The learner will be able to name signs and symptoms of failed outpatient cellulitis treatment which may lead to admission to hospital.

Outpatient parenteral antibiotic therapy has been successfully used to both limit admissions safely and to reduce length of stay for medically stable patients. Although cellulitis may be managed with oral medications, the current economic climate has limited access for basic medical care. Patients are presenting to Emergency Rooms (ER) with advanced illness, no Primary Care Provider (PCP), and no means for follow up care.

Problem: There is a need to create innovative services to reduce length of stay and to divert patients which would otherwise be admitted. Often due to limited bed availability, patients have lengthy stays in the overwhelmed Emergency Room.      

Proposed Solution: Nurses worked with other disciplines to develop a cellulitis pathway. This pathway allows every patient presenting with cellulitis access to parenteral antibiotics and wound care with education on treatment and prevention. The Nurse Practitioner supplies follow-up for patients who do not have a PCP.

Methods: After screening for sepsis, the physician orders IV antibiotics to be administered now and for four additional days in the outpatient department. The nurse circles area of erythema, supplies a pictorial on how the patient can provide self care, and a follow up appointment in the Outpatient service to receive IV antibiotic and wound care for the following four days. The Nurse Practitioner evaluates and prescribes oral antibiotics on day three or four for patients who do not have a PCP or extends the length of IV antibiotics as needed.Evaluation: This pathway is evaluated by the patients with the Survey Monkey on the last day of service. Further evaluation will include numbers of patients admitted to hospital with cellulitis who stayed less than three days and less than five days. Number of admissions and length of stay in the ER will be collected on all patients diagnosed with cellulitis.