1996 OPEN FORUM Abstracts
BRONCHODILATOR PROTOCOL PILOT STUDY: A SUCCESSFUL IMPLEMENTATION
Denise Shangle, RRT; Tracy Christopherson, RRT; Mike Fillenworth, BS, RRT; Deb Bouwens, RRT; Sandy Weber, Carla Gianoli, RRT; Karen Warmouth, RRT; Matt Kilroy, BS, RRT. Butterworth Hospital Respiratory Care Department
Introduction: From November through December 1995, we implemented a bronchodilator protocol pilot study on two pediatric and two general medicine floors at our institution. The purpose of the protocol was to ensure that patients received the appropriate bronchodilator therapy, to decrease the amount of non-indicated therapy, and to demonstrate that Respiratory Care Practitioners (RCP) were capable of adjusting bronchodilator therapy within protocol guidelines. Method: Following literature review, a protocol was developed that enabled the RCP to adjust the frequency and modality of bronchodilator therapy without a direct physician order. Physician consensus was obtained. An aggressive staff education plan was developed and instituted. All credentialed RCPs participated in the protocol implementation. All patients admitted to the selected floors and ordered for branchodilator therapy were entered into the pilot study. Data was collected and compared to that available from November through December, 1994. Results: Two-hundred and eleven patients were enrolled into the pilot study. RCPs made 134 changes per protocol (Frequency of therapy decreased: 53; MDIs turned over to nursing for administration: 40; modality changes: 16; Therapy discontinued: 15; Therapy reordered without changing frequency: 7; frequency of therapy increased: 2). Physicians ordered "No protocol" four times (3%) and disagreed with RCP changes eight times (5%). No adverse patient incidents were reported as a result of the protocol. The average amount of time a patient required our services dropped from 3.91 days pre-protocol to 2.37 days during the pilot study. RCPs saved approximately 20 hours of time in contacting a physician for changes. This resulted in an estimated cost savings of $2000 a year on these floors. Conclusion: Our data demonstrates that by using the protocol, our RCPs were able to ensure that patients were receiving appropriate bronchodilator therapy while reducing the amount of non-indicated therapy. The success of our program is due to the education and strength of our staff along with the support of our medical directors. Communication skills and networking also played an important role. Because of its success, the pilot study was continued through March and then implemented house wide in April, 1996.