The Science Journal of the American Association for Respiratory Care

1995 OPEN FORUM Abstracts

Pediatric Oxygen (O2) Weaning Protocol: Successful Implementation and Cost Savings

M. Miller, RRT, T. Mitchell, RRT and D. Habib MD Medical University of South Carolina Children's Hospital, Charleston, South Carolina

Objective: To develop a Pediatric O2 Weaning Protocol that is effective in reducing unnecessary O2 administration and patient charges for general ward patients. Materials and

Methods: A literature search revealed no previous information on pediatric O2 weaning protocols. Physician surveys were distributed to the Pediatric physicians (n=22) to determine their O2 weaning preferences, i.e.- frequency and increments of weaning, methods of O2 delivery and the use of pulse oximetry. Based on the results of the physician survey and Clinical practice Guidelines for adult O2 weaning, a pediatric protocol was developed. The protocol was designed to: 1. identify potential patients for weaning (SpO2's >95%) 2. wean patients by standard parameters: SpO2> 95%, q³ hour intervals, 5% or 0.5 liter decrements, to room air or specified physician parameters 3. monitor the patient for any adverse outcomes through occurrence reports (documentation of respiratory distress/ failure associated with the weaning process) and twelve hours of post-weaning pulse oximetry 4. reinforce patient assessment and monitoring during the weaning process. The protocol was applied to all general pediatric patients with both acute and chronic O2 needs, except post-op cardiothoracic patients and patients with sickle cell disease. Patients were stabilized for twelve hours on O2 therapy, unless ordered by the physician to initiate the protocol earlier. Protocol efficiency was determined by reviewing ten randomly selected pre-protocol and 10 post-protocol O2 patients (19 acute/1 chronic) for. number (#) of SpO2 checks, # of SpO2 checks >95%, # of decreases or increases in O2 therapy, average patient days on O2, average patient cost, total % of weaning that occurred, and documented adverse outcomes.

Results:

Pre-Protocol Post-Protocol (*=p < .05)

# SpO2 checks 139146

# SpO2 checks> 95% 122106

# O2 decreases333*

# O2 increases111*

Average days on O2 2.41.2*

Average patient charges $576.00 $288.00*

% of weaning for SpO2>95% 2% 31%*

Adverse outcomes0 0

Conclusion: 1. Prior to protocol implementation, a negligible amount of O2 weaning was performed by the RN/RT staff. 2. The protocol appears to be safe without any adverse outcomes noted. 3. The Pediatric Oxygen Weaning Protocol has substantially reduced both oxygen administration and patient cost.

OF-95-166

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