The Science Journal of the American Association for Respiratory Care

2010 OPEN FORUM Abstracts

IMPACT OF A THERAPIST-DRIVEN PROTOCOL INCLUDING INCENTIVE SPIROMETRY AND HIGH-FREQUENCY CHEST-WALL OSCILLATION ON INCIDENCE OF POST-OPERATIVE PNEUMONIA.

Eileen Luley1, Kristin McFall2; 1Cardiopulmonary, Rome Memorial Hospital, Rome, NY; 2Respiratory Care, Hill-Rom Respiratory Care, St. Paul, MN

Background: Pneumonia is common in post surgical patients. Reported mortality rates for pneumonia range from 20% to more than 45%. In our hospital, pneumonia rates were 1.2 and 2.9 per 1,000 post-surgical days in 2005 and 2006, respectively. As a quality improvement initiative, the Cardio-Pulmonary Department developed a patient-centered protocol including Incentive Spirometry (IS) and High-Frequency Chest-Wall Oscillation (HFCWO). We report the pneumonia rates for two years following the February 2007 implementation of this protocol. Methods: Patients with orders for IS were instructed prior to surgery on IS and cough techniques. 4 hours post-surgically, patients were evaluated by therapists assessing their ability to achieve 75% predicted value of IS therapy. Major surgery and other high risks patients unable to meet IS target progressed to treatment with HFCWO BID for 48 hours, and then re-evaluated. Retrospective review of infection control records compared incidence of pneumonia in the facility from 2005 to 2009. A preliminary cost savings calculation compared cost of care for two post-surgical patients that developed pneumonia to cost of care for patients with identical diagnoses that did not develop pneumonia. Results: Pneumonia rates decreased following implementation of the IS/HFCWO protocol. The number of post surgical patients admitted to our units and the corresponding pneumonia rates for each year is shown below. A preliminary estimate of cost saving was $288,000 following implementation of the therapist IS/HFCWO protocol. Conclusions: Reduction in post-operative pneumonia occurred after implementing a therapist-driven protocol for all post-operative patients. Our results suggest routine follow-up with post-operative patients ensuring deep breathing and adequate secretion clearance may result in better patient outcomes and cost savings. Sponsored Research - None * Includes non-post-operative patients. **Protocol implementation 2/07.