2007 OPEN FORUM Abstracts
EFFECT OF IMPLEMENTATION OF A NONINVASIVE VENTILATION PROGRAM ON RESPIRATORY THERAPISTS' ATTITUDES AND BELIEFS
C. A. Hirsch1, D. Seder1, J. Dziodzio 1, S. Whitten1, S. Brewer1, J. Roy1, S. Mette1
Background: Noninvasive positive-pressure ventilation (NPPV) improves outcomes when used as adjuvant therapy in acute respiratory failure (RF) due to chronic obstructive pulmonary disease (COPD), heart failure (CHF), and certain other diseases. NPPV is underutilized, and one barrier to its routine use may be the attitudes and beliefs of respiratory therapists (RTs). We surveyed RTs before and after implementation of a NPPV program to determine the effect of the program on RTs attitudes and beliefs.
Methods: A multifaceted NPPV program was developed, based on clinical best practices and disease-specific protocols. Between May and October of 2006, NPPV-specific ventilators and masks were introduced, along with didactic and hands-on education for respiratory therapists, physicians, and nurses. Therapists were anonymously surveyed before (n=82) and 10 months after (n=80) this intervention, using a Likert scale to assay general attitudes toward NPPV.
Results: Response rates were 76% and 71%. 80% of respondents reported at least 10 experiences with NPPV annually. More therapists believed they knew which patients are appropriate for NPPV after the intervention (68% v 86%, p=0.02), and there was a dramatic drop in the reporting of equipment as a barrier to NPPV after the purchase of new NPPV ventilators (58% v 18%, p<0.001). There was a trend toward more therapists considering themselves well trained in the delivery of NPPV (77% v 88%, p=0.16) after the intervention. Only 58% and 68% of RTs (p=0.24) believed that NPPV prevented RF in COPD, an indication strongly supported by medical literature, while over 95% (both groups) thought NPPV could prevent RF in CHF. Overall, the experience level of RTs did not correlate with their beliefs. Although a trend of more therapists reporting positive experiences with NPPV after the intervention existed (61 v 72%, p=0.22), commonly reported barriers, including staffing levels (46%), RT knowledge and training (33%), physician knowledge and training (60%), and a lack of teamwork between care providers (46%) did not change significantly.
Conclusions: The implementation of a NPPV pathway had modest effects on RT attitudes toward the efficacy of NPPV, but did little to address RT-perceived barriers to providing high quality NPPV. Quality improvement initiatives should target RT concerns about barriers to providing high quality NPPV.