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%.