2006 OPEN FORUM Abstracts
LEARNING HOW TO PROVIDE CONSISTENT EFFECTIVE AIRWAY CLEARANCE TO PATIENTS WITH CYSTIC FIBROSIS
CINCINNATI CHILDRENS HOSPITAL
Edward
Conway, RRT, Walter Blower, RRT, Kim Schultz-Eghtesady,
Adrienne
Prestridge, M.D., Jamie L. Wooldridge, M.D.
Background: Cystic Fibrosis (CF) is a life threatening disorder that affects the
flow of salt and water within the airway creating thickened mucus. This leads to infections, inflammation, lung
destruction, and eventual death. Consistent and effective airway clearance is
critical in preventing the build up mucus and prolonging the life of patients
with CF. The CF Care Center at Cincinnati Children's Hospital has undertaken a
major initiative to improve the health care we deliver to our patients with CF.
As part of this initiative; parents reported significant variation in the
delivery of inpatient and outpatient airway clearance treatments (ACT). This
prompted us to examine how we deliver and teach airway clearance in the
inpatient and outpatient settings with the goal of improving patient outcomes.
Method: A
multidisciplinary team including patients, parents, pulmonary physicians,
respiratory therapists, nurses, and a physical therapist was established. This
team spent 4 months reviewing current literature and benchmarking with other CF
centers. The conclusion supports that
all ACT modalities were equally effective if performed correctly with good
patient participation. The team developed protocols for each ACT modality. The goal
of these protocols was to provide effective and consistent ACT to patients with
CF in the inpatient and outpatient setting. The RT's attended 8-hour didactic
workshop for education on these newly developed protocols including classroom
instruction with participation from all RTs.
At the completion of the workshops, the protocols were tested and
implemented on 2 units. Two months later evaluation by patients, parents, and
RTs showed continued inconsistency in ACT delivered. The conclusion from this
evaluation that RTs did not fully understand the new ACT protocols and the
didactic workshops were not sufficient to result in consistent and effective
ACT. The team determined a need for
one-on-one education with competency testing to achieve consistency. Competencies
were developed for each ACT protocol and consisted of:
1.
Demonstration of
current practice by each RT
2.
Detailed
reviewing of the new ACT protocol with each RT and demonstration of knowledge
of the protocol
3.
Observation (one
month after demonstration) of each RT performing ACT with a patient one month
later to assess retention of knowledge of ACT protocol
Each RT was scored for
knowledge of the ACT protocol. The pre-scoring confirmed the failure of the
eight hour didactic workshops in educating RTs on the ACT protocols. The
post-scoring revealed that one-on-one training was necessary to insure RT
knowledge of the ACT protocols. The one month observation displayed improved
reliability of consistent effective delivery of ACT by RTs.
Results: Data
collected from February 2005-September 2005 showed that at the time of
institution of the program RT's were delivering best practice of P&PD 9% of
the time. After the one on one education sessions data showed in September 2005
that the RT's were providing best practice for P&PD 95% of the time.
Conclusion: Successful implementation of change in practice for ACT is achievable
with interdisciplinary collaboration between patients, parents, RTs, and the CF
Care team. Ongoing collection of data,
feedback to health care providers and continual refinement is necessary for
sustained reliability of the improvement at 100%.