The Science Journal of the American Association for Respiratory Care

2010 OPEN FORUM Abstracts

THE THERAPIST DRIVEN POLICY AND PROTOCOL; POSITIVE CHANGE FOR PATIENT CARE

Joel M. Brown, Justin Stevenson, John S. Emberger, Lori Killian, Francis A. Gott, Melani Murphy, Vinay Maheshwari; Christiana Care Health System, Newark, DE

Background: When patients experience recoverable acute respiratory distress, non-invasive positive pressure ventilation (NIPPV) is often considered. One of the biggest challenges when providing this life saving therapy is acquiring immediate physician direction when the patients status changes. In order to remove this challenge we developed a Respiratory Therapist Driven Protocol (RTDP) for the management of NIPPV. In this project we retrospectively reviewed the outcomes of our COPD patients that required NIPPV before and after the RTDP was implemented. Methods: The RTDP for NIPPV was implemented on January 30th 2009. The RTDP included parameters that allowed the RCP to adjust IPAP, recommend level of care, trial patients off NIPPV, and discontinue if appropriate. Using electronic respiratory documentation we retrospectively analyzed all adult COPD patients who were admitted to the hospital and were ordered continuous NIPPV. The data was collected from July 2008 to April 2010. The data was divided into two different categories: Pre RTDP Group (July 2008 to January 2009) and Post RTDP Group (February 2009 to April 2010). All patients who were ordered invasive ventilation during their stay were excluded. For each group we collected the following data: IPAP settings, length of stay on NIPPV (LOSniv), hospital length of stay (LOSh), and the number of patients transferred to the ICU’s or stepdown units. We also identified patients who were still on NIPPV within 48, 24 and 12 hours of discharge. Results: We identified a total of 765 COPD patients in the Pre RTDP group and 132 (17.3%) of them received continuous NIPPV. We identified 853 COPD patients in the Post RTDP group and 160 (18.8%) received continuous NIPPV. See table for additional data. Conclusion: There was no difference in IPAP level or the number of patients requiring NIPPV within 48 hours of discharge Pre or Post RTDP. Fewer patients required NIPPV within 24 and 12 hours of discharge in the Post RTDP group. The RTDP resulted in a statistically significant decrease in LOSniv and LOSh. More patients were transferred to the stepdown unit and fewer patients were transferred to the ICU for care in the Post RTDP group. Although the RCP’s used the same IPAP settings, they were able to discontinue NIPPV quickly which may have contributed to a reduced hospital stay. The use of a NIPPV RTDP is an effective way to manage COPD patients requiring continuous NIPPV. Sponsored Research - None

Pre and Post NIPPV RTDP Data

*p=≤0.01