2012 OPEN FORUM Abstracts
IMPLEMENTATION OF A NEWLY DEVELOPED CLINICAL GUIDELINE USE OF HIGH FLOW NASAL CANNULA OUTSIDE THE ICU.
Maureen Ginda, Lisa Tyler, Raymond Matthews, Patricia Achuff, Linda Allen-Napoli; Respiratory Care, The Childrens Hospital of Philadelphia, Philadelphia, PA
Background: High Flow Nasal Cannula (HFNC) is often utilized to decrease work of breathing in pediatric patients with primary pulmonary pathology such as bronchiolitis. Often there are patient safety concerns regarding aggressive use of high flows and FiO2 on general pediatric floors. The identification of specific flow-rate boundaries for HFNC is not well established. Utilization outside the intensive care unit where monitoring systems and staffing ratios are stretched adds to safety risks. Methods: A HFNC guideline was created employing FiO2 and flow limitations for a variety of age ranges. All staff (RT/RN/MD) who worked in designated HFNC patient care areas were educated on the guideline for standardization and safe practice. The guideline was implemented in December 2011 on general pediatric floors with high patient census of primary pulmonary pathology. Data was reviewed monthly to evaluate guideline adherence, address additional educational needs, and communicate any patient safety concerns. Results: 25 patients met clinical criteria for use of HFNC on the general pediatrics floors from December 2011 through May 2012. In 80% (20/25) of patients HFNC guidelines were followed. In 4 patients the flowrate and FiO2 were increased above recommended guidelines for clinical stabilization prior to transfer to the ICU. In 76% (19/25) of patients, at least one rapid response call was made. 4% (1/25) required a code call for acute respiratory compromise. 52% (13/25) of patients required transfer to the ICU for care. The patients had the following diagnoses: 72% (18/25) RSV/Bronchiolitis, 20% (5/25) respiratory distress, and 8% (2/25) asthma/pneumonia. Conclusion: High flow nasal cannula can be successfully implemented on general pediatric floors using clinical guideline and structured multidisciplinary education plan. Sponsored Research - None