The Science Journal of the American Association for Respiratory Care

2004 OPEN FORUM Abstracts

PRE/POST OUTCOMES OF AN EDUCATIONAL PROGRAM ON THE USE OF NASOPHARYNGEAL SUCTION (NPS) WITH A CATHETER VS OLIVE-TIPPED DEVICE (OTD) IN SUCTIONING BRONCHIOLITIS PATIENTS.

Kim Bennion BS RRT, Julie Ballard BS RRT, Scott Daniel RRT, & Debbie Forbush BS CRT, Respiratory Care Services, Dixie Regional Medical Center, St. George, Utah.

Introduction:
We teamed with 3 other IHC medical centers in the implementation of a bronchiolitis clinical practice guideline (CPG). The CPG specified utilizing the technique of NPS with a catheter inserted into the hypopharynx. It was initially our impression that using an OTD which uses suction but does not advance into the hypopharynx would be as effective. Outcomes from the 2002-2003 season (November 1-April 30) identified that suctioning with the OTD did not appear to replicate the results found at 3 other IHC medical centers who utilized the catheter technique. Prior to this last season, a comprehensive educational program was provided which included the standardization of the procedure of NPS with a catheter. Detailed emphasis on the outcomes of a catheter vs the OTD were reviewed. The OTD was removed from the floor stock to enhance compliance to catheter utilization during the 2003-2004 season.

Methods:
The Bronchiolitis Score (BS), a respiratory symptom-based scoring system, was used to determine patient (pt) response to interventions. The BS is based on respiratory rate, breath sounds & retractions, each being scored on a scale of 0-3. An improvement was defined as a decrease in the total score by > 1 from pre- to post-NPS intervention. Data on NPS interventions & scores were retrospectively extracted from our data systems for the 2002-2003 & 2003-2004 seasons. Inclusion criteria were: (1) diagnosis of bronchiolitis, (2) age < 24 months, (3) NPS during their hospital admission, and (4) a complete set of scores (baseline and post suction). Pts were scored as to whether their scores improved, remained unchanged or worsened after each suctioning event.

Results:
Outcomes comparing our 2002-2003 (utilizing the OTD) and 2003-2004 (utilizing the catheter) seasons are reported in Table 1. When comparing suctioning performed with a catheter versus the OTD in bronchiolitis pts, a statistically significant improvement (P < 0.05) was noted via Chi square analysis when the catheter technique was utilized.

Table One: Comparing NPS Outcomes at DRMC for Two Seasons---
The Catheter versus OTD

Pt. Responses to NPS Events 2002-2003 (OTD) # (%) NPS Events 2003-2004 (NPS) # (%) NPS Events
Improved 202 (26) 742 (49)
No Change 478 (63) 700 (46)
Worsened 82 (11) 68 (5)
Total # NPS Events 762 (100) 1510 (100)

Discussion: Suctioning bronchiolitis pts with a catheter has become our standard of care. The importance of the utilization of benchmanrking and outcomes to identify areas for process improvement coupled with educational activities to improve clinical practice cannot be over emphasized.

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