2005 OPEN FORUM Abstracts
"Intra Reliability Between Respiratory Therapist and Nurses Utilization of a Respiratory Score in Pediatric Asthma and Bronchiolitis"
Cincinnati Children's Hospital, Cincinnati Ohio Edward Conway, RRT, Shirley Salway, RN, BS,Edwardo Mendez, RN, MPH Emily Smith, PNP, MS, Alka Patel, MD,PhD
Background: Asthma and bronchiolitis constitutes a significant proportion of inpatient admissions and resource utilization at Cincinnati Children's Hospital (CCHMC). CCHMC is continually striving to improve delivery of evidenced based standard of care while increasing (decreasing) resource utilization. Currently we utilize an evidenced based asthma guideline with Respiratory Therapist (RT) driven weaning of bronchodilator therapy, as well as a bronchiolitis guideline which allows for the RT to continue or discontinue bronchodilator therapy through a respiratory score. The nursing staff evaluates asthma and bronchiolitic patients and makes subjective recommendations, without utilizing the evidenced based respiratory score. A Multidisplinary team (RT, RN, physciain) sought to develop a unified RT/RN respiratory score with the goal of improving communication between the two groups in order to facilitate better care.
Method: These steps were taken:
1. A failure mode analysis to determine if RN's needed to utilize a respiratory score
2. Translate the nurses subjective measurements into a respiratory score which is evidenced based
3. Determine if there was a discrepancy in respiratory scores between RT and RN
4. Try to migrate any discrepancy through RT education of RN's
Results: In the failure mode analysis of bronchiolitis, when the RN's subjective assessment was changed to a respiratory score 60% of patients should have received an intervention, resulting in over use of bronchodilator therapy in patients with bronchiolitis. This identified the need for the RN's to utilize a respiratory score. In 33% (n of 25) of acute asthmatics (acute defined by admission assessment), RN's scored the patient's respiratory status higher than the RT resulting in potentially more bronchodilator treatments being administered. This discrepancy in scoring resolved as the patients asthma exacerbation resolved. The area of discrepancies included air exchange, I:E ratios and wheezing. Specifically, RN's did not understand the concept of I:E ratio, an important component of asthma care. This demonstrates the need for RN education on scoring of acute asthmatics.
Conclusion: Our next step is to develop a scoring tool that is mutually understood between both RN's and RT's. Education of the new scoring system will be conducted for both RN's and RT's. Our hope is to have a unified assessment scoring tool that will be evidenced based for treating our asthma and bronchiolitis patients.