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.