The Science Journal of the American Association for Respiratory Care

2010 OPEN FORUM Abstracts

IMPACT OF AN ORDERSET AND EDUCATION ON INHALED NITRIC OXIDE USE IN ADULTS.

John S. Emberger1, Lori Killian1, Joel M. Brown1, Francis Gott1, Vinay Maheshwari1,2; 1Respiratory Care, Christiana Care Health System, Newark, DE; 2Medicine, Christiana Care Health System, Newark, DE

BACKGROUND: Inhaled nitric oxide (INO) has been used in adult populations as supportive therapy for pulmonary hypertension, right heart failure and hypoxemia. The only FDA approved indication for use is term neonates with PPHN. Adult use has failed to prove long term outcomes benefits. INO is sometimes used in our adult ICUs for pulmonary hypertension, right heart failure and hypoxemia. We suspected that our INO adult use was higher than appropriate, without the use of a guided protocol. We created a hospital approved orderset for INO and completed education about INO in adults. We wanted to determine if the INO orderset with education would impact the use of INO. METHODS: INO orderset construction and education occurred between Jan 2009 and June 2009. INO orderset included discontinuation for non-responders and a weaning algorithm. Education included ventilator optimization prior to INO use. We retrospectively reviewed INO use in two specific time periods: PRE-ORDERSET (July 2008 to Dec 2008) and POST-ORDERSET (July 2009 to Dec 2009). Data collected included number of patients with severe hypoxemic respiratory failure (SHRF), number of INO patients, patient survival, duration on INO and ventilator settings. SHRF was defined as: patients requiring ≥ 60% FiO2 and ≥ 10 PEEP. RESULTS: See table for main results. Overall hours of INO use in six month periods were reduced by 60%. Patients were on INO an average of 5.4 days Pre-Orderset and 3.4 days Post-Orderset (p < 0.05). No change was noted in ventilator modes used and mortality of patients in SHRF during the Pre-Orderset and Post-Orderset time periods. CONCLUSION: After initiating an INO orderset and educating the optimization of ventilation: #1) Less patients with SHRF were placed on INO, #2) Patients placed on INO had shorter use of INO, #3) Physicians used higher PEEP, before initiating INO, #4) There was a 60% reduction in the use of INO which would result in a large cost savings to the hospital and patients. Sponsored Research - None INO Use PRE-ORDERSET (July08-Dec08) and POST-ORDERSET (July09-Dec09)