2002 OPEN FORUM Abstracts
ASSESSMENT BY RESPIRATORY THERAPIST IS A KEY FACTOR IN REDUCING BRONCHODILATOR THERAPY IN BRONCHIOLITIS
Edward Conway, RRT Mary Pat
Alfaro, M.S., Harry Atherton, M.S., Pamela Schoettker, M.S., Kate Turck, B.S.
Hospital Medical Center, Cincinnati, Ohio
Background Bronchiolitis, an acute illness affecting young children, involves inflammation of the lower airways, making breathing difficult. The routine use of bronchodilator therapy continues to be a common treatment for these patients even though the evidence supports treatment only if it results in documented clinical improvement.1-3 Therapies shown to be effective include suctioning and maintaining hydration.4 Part of our commitment to pursuing perfection in health care includes reducing the unnecessary use of bronchodilators. For fiscal year 2002, our evidence-based clinical practice guideline for acute bronchiolitis was revised to encourage the use of respiratory function assessment to determine the need for and effect of bronchodilator treatment.
Methods The revised guideline was implemented November 28, 2001. It recommended nasal suctioning and immediate assessment of respiratory function by respiratory therapists before and after the suctioning, prior to a trial treatment with a bronchodilator. Respiratory function was assessed via a respiratory score that included consideration of respiratory rate, accessory muscle use, retractions, wheezing, and I:E ratio. If the post-suctioning score showed a dramatic improvement in respiratory function, the bronchodilator therapy was not recommended. If a bronchodilator treatment were given, respiratory scores are obtained before and 30 minutes after its administration. The guideline recommended that no further bronchodilators be given if no positive response to treatment was documented.
Patients admitted with a diagnosis of acute bronchiolitis and no other medical history were eligible for the bronchiolitis guideline. The number and frequency of bronchodilator treatments for patients admitted between 12/01/2001 and 3/31/2002 were compared to patients admitted during the same time period of the previous bronchiolitis season (12/01/00 03/31/01).
Results Following implementation of the revised guideline, the proportion of patients receiving any bronchodilator treatment decreased from 61% to 57%. Patients receiving only one trial of a bronchodilator treatment increased slightly from 24% to 28%. The proportion of patients who received more than one bronchodilator treatment decreased significantly from 37% to 30% (p = 0.01) and the mean number of treatments decreased from 3.7 to 2.5 (p = 0.03). When considering only patients who received bronchodilators, the mean number of doses decreased from 6.0 to 4.5 (p < 0.01).
Conclusion The use of the respiratory assessment score had a significant impact on the frequency and intensity of bronchodilator treatments. The role of the respiratory therapist was critical in the decision-making process.
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