I Cough

At Boston Medical Center, a multidisciplinary team developed a strategy to reduce pulmonary complications, based on comprehensive patient and family education and a set of standardized electronic physician orders to specify early postoperative mobilization and pulmonary care. This work was in response to National Surgical Quality Improvement Program data showing that the hospital was a high outlier for all measured postoperative pulmonary complications. Designated by the acronym I COUGH, the program emphasizes Incentive spirometry, Coughing and deep breathing, Oral care (brushing teeth and using mouthwash twice daily), Understanding (patient and family education), Getting out of bed at least three times daily, and Head-of-bed elevation.