The Science Journal of the American Association for Respiratory Care

2007 OPEN FORUM Abstracts

ACUTE ASTHMA PROTOCOL: UTILIZING A TEAM APPROACH TO DECREASE LENGTH OF STAY

S. Iniguez1


Background: A multi-disciplinary group was formed to evaluate how best to decrease our length of stay for our asthmatic patients.

Method:
Our current practice was reviewed and several areas for improvement were noted. It was decided to conduct a pilot and use a more cohesive team approach to facilitating readiness for discharge. Areas targeted for modification were our Beta-2 weaning and oxygen weaning protocols and the desire to establish new discharge criteria.
-The Beta-2 weaning was continued if the patient showed no signs of respiratory distress as determined by our Clinical Respiratory Score (CRS), previously the patient had to be free of wheezes.
-The oxygen weaning protocol was modified to accept saturations >92% and once the patient was on room air the pulse oximeter was discontinued. A spot check pulse oximetry was performed after one hour on room air to ensure that the patient was still maintaining saturations >92%.
-Upon reaching Q3 beta-agonist therapy a trigger placed in the pre-printed orders initiated asthma education and a social worker consult if needed to facilitate transportation on discharge.
-New discharge criteria were established, the patient had to be stable off oxygen and IV therapies and on Q4 beta-agonist for 8 hours.

Results:
There were 188 pediatric asthmatic encounters, 143 controls and 45 interventions.
Mean length of stay for all was 2.35
Intervention 1.71 vs 2.55 control

Conclusions:
The use of pre-printed orders was instrumental in ensuring that all aspects of care were conducted in a timely manner. The Acute Asthma Protocol has now been initiated in all our acute care areas and we continue to assess its progress.

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