The Science Journal of the American Association for Respiratory Care

2007 OPEN FORUM Abstracts

EVALUATION OF AN AUTOMATIC STOP ORDER PROCOTOL FOR RESPIRATORY CARE MEDICATION THERAPY

E. Bearden1, J. Hargett1, J. Sabo1

The use of respiratory care protocols has been shown to decrease unnecessary treatment and reduce health care costs. An automatic stop order program (ASO) was developed to allow respiratory therapists to discontinued medication treatments after 72 hours of therapy. Exclusion criteria from the ASO program included patients in the ICU, on home respiratory medication therapy, post transplant, receiving specialty medications (such as Pulmicort or antibiotics) or those with an artificial airway. The ASO was not implemented on patients with airflow restrictions after 72 hours of therapy. The protocol was approved by the hospital’s Pharmacy, Nutrition, and Therapeutics Committee prior to initiation of the program. Documentation of the protocol was made in the department’s information system (Mediserve, Inc.) and in the physician’s order section of the medical record. A pilot program was initiated on 5 or 20% of the acute care units. 1724 patients were evaluated during the first months of the protocol. 387 patients (25% of the orders) were eliminated from the ASO program due to the exclusion criteria. 41 patients had orders written requesting protocol not be implemented, 38 written by the same physician. Out of the remaining 1296 patients, 671 patients were discontinued by protocol at the 72 hour mark. 42 patients were discontinued by the physician prior to the 72 hour automatic stop, 583 were discharged before the 72 hour discontinuation, and 124 patients were reordered for therapy. 105 patients were continued on therapy, as assessed by the respiratory therapists. None of the 671 patients discontinued by protocol were re-ordered for therapy for medical indications, after the 72 hour discontinued time. Therapists receive regular feedback on how they are performing the protocol steps and the effectiveness of the protocol in the patient’s medical management. Upon house wide institution of the ASO protocol in all non-ICU area it is projected 6.60 FTEs annually can be reassigned to higher priority respiratory care related patient interventions.

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