The Science Journal of the American Association for Respiratory Care

2005 OPEN FORUM Abstracts

Distribution of Selected Airway Clearance Modalities in Pediatric Patients Using an Assess & Treat Algorithm

Kathleen Deakins RRT-NPS, Mary Lou Drahnak RRT-NPS, Robert L. Chatburn RRT-NPS, FAARC Rainbow Babies & Children's Hospital Cleveland, OH

Background: The Respiratory Care Consult Service (RCCS) is a standardized assessment and treatment program designed to assist physicians in choosing the appropriate Respiratory Care plan for the patient. Historically, goals of the RCCS have been shown to be successful in adult patients. Applying a RCCS for pediatric patients often requires some specificity due to developmental needs that affect the delivery of care. The purpose of this protocol evaluation is to determine the distribution of selected therapeutic modalities in pediatric patients resulting from implementing an airway clearance algorithm, and its associated protocols on pediatric patients.

Methods: Over a six-month period in 2004, 191 pediatric patients with physician's orders for airway clearance therapies (ACT) were evaluated through the RCCS using a modified adult airway clearance algorithm with pediatric-specific requirements such as age, weight and known responder criteria. Physicians were aware of the consult service practices and were notified about the choice of treatment modality and proposed Respiratory Care plan at the conclusion of each consult. Patients using other care paths or protocols such as Asthma Care Path and Cystic Fibrosis Carepath, or Cardiothoracic patients were not considered for evaluation through the RCCS. Chronic care patients receiving baseline respiratory care treatments at home were consulted and treatment type remained the same unless rendered ineffective during the acute exacerbation of the disease process. The distribution of treatment modalities is displayed in this graph (as actual numbers of patients).

Results:

Conclusion: Chest physiotherapy, primarily indicated for presence of a focal infiltrate, accounts for a large portion of ACT in this population; as pediatric patients often meet this criteria, and when less than two years of age, may not be eligible for other modalities. Selecting airway clearance modalities derived from algorithm-based decision tools allows standardized assessment of the effectiveness of treatment, helps identify best practice goals and assists in the derivation of benchmarking data against non-protocol-based treatment in children.

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