The Science Journal of the American Association for Respiratory Care

2011 OPEN FORUM Abstracts


Lucas T. Schulz1, Anne L. Flaten2, Barry C. Fox3; 1Pharmacy, University of Wisconsin, Madison, WI; 2Respiratory Care Services, University of Wisconsin, Madison, WI; 3Infectious Diseases, University of Wisconsin, Madison, WI

Background Sputum induction, using 3% hypertonic saline, is performed to enhance the removal of mucus when patients are not able to spontaneously produce a specimen. Sputum inductions are commonly ordered by prescribers to evaluate acid fast bacilli (AFB) or lower respiratory tract infection (LRTI). At a recent department meeting, Respiratory Therapists (RT) expressed concern about the efficacy and quality of inductions. We sought to validate these concerns. We implemented a quality improvement project aimed to determine the efficacy and quality of sputum induction procedures and determine if action steps were needed to enhance patient care. Methods We identified all sputum induction charges during calendar year 2010 from an administrative billing file. A medical record review evaluated procedure efficacy and quality. Efficacy was defined as a procedure resulting in sputum production and transport to the lab. Quality was defined as sputum production with gram's stain result of < 10 polymorphonuclear white blood cells and < 10 squamous epithelial cells. Pediatric patients and collection for AFB identification were excluded. A meeting with respiratory therapy, infectious disease physician and antimicrobial stewardship pharmacist evaluated the results. Results From 1/1/2010 to 12/31/2010 there were 131 charges for sputum induction. Fifty patients were excluded (AFB testing; n=42, patient < 18 years old; n=4, improper charge; n=3, induction on the same calendar day; n=1). Eighty-one patients had orders for induced sputums. Induction was effective in 75.3% (n=61/81) cases. The microbiologically useful (quality) success rate of the effective sampling was 43% (26/61). Programming in our eMR was created to increase use of RT-induced sputums after consensus was reached during an inter-disciplinary meeting. Conclusion RT-induced sputum samples provide high quality specimens in lower respiratory tract infections. This method may provide useful information to prescribers when making therapeutic decisions.
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