2006 OPEN FORUM Abstracts
Development, Implementation, and Auditing of a COPD/ASTHMA Disease Specific Protocol
Payne BS RRT NPS,
M. Emhoff AS RRT, F. Busta AS RRT RPSGT, J. Martin BS RRT. MetroHealth Medical Center, Cleveland Ohio.
BACKROUND: Since 1995 a Therapist Driven Protocol (TDP) has been used in the MetroHealth System (MHS). Following a physician order, the respiratory therapist would assess the need for bronchodilator therapy/frequency, oxygen, and hyperinfla-tion therapy if indicated. Daily written reassessments are performed to titrate therapy. Prior to 2004, reassessment compliance showed wide fluctuations between 38-92%. This was far below accepted compliance rate of 90%. The TDP standing order (SO) sheet created used the COPD Gold Standards and NIH Asthma Guidelines. Improve-ment in compliance was expected due to standardization and a comprehensive care approach. SO include disease specific medications, education, discharge criteria, and follow-up outpatient care. The creation and education was completed using a multi-disciplinary approach. The new protocol pilot began July 2004, and then spread to all areas in the MHS. We sought to determine if the implementation of SO would improve compliance with PEFR, reassessments, smoking, and disease education.
Method: Chart reviews began two months after implementation. Data collection of 189 COPD/Asthma patients was collected during three time periods; Time 1 (T1) Aug-Sep 2004, Time 2 (T2) Jan-Feb 2005, and Time 3 (T3) Aug 2005-Jan 2006. Following the first data collection period additional staff education was provided. Noncompliant staff received individualized instructions from supervisors. A newly created position of COPD/Asthma Clinical Specialist was used to educate and monitor the third time period. Data collection from patients consisted of; 1) Are patients questioned on smoking history and if ready to quit, material for the Smoking Cessation pro- gram provided, 2) Verbal and/or written disease specific patient education document- ed, 3) Frequency of PEFR performed before and after each bronchodilator therapy, and 4) COPD patients assessed minimally each day using PEFR, breath sounds, and dyspnea.
Results: Sample sizes were 30, 80, and 79 for the three time periods respectively. The following percent compliance was documented: 1) smoking questions asked 90%(T1), 89%(T2), 97%(T3), 2) verbal and written patient bedside education 36%, 36%, 60%, 3) asthma pre/post PEF measurement 6%, 57%, 71%, and 4) COPD daily assessment 82%, 76%, 78%.
Conclusion: As indicated in the results, compliance rates continued below 90%. A clinical specialist now follows patients daily, monitors' compliance, and has implemented process improvement. Current data suggests further improvement.