The Science Journal of the American Association for Respiratory Care

2012 OPEN FORUM Abstracts

IMPROVING TRAUMA PATIENT OUTCOMES THROUGH ADDITIONAL PULMONARY HYGIENE INTERVENTIONS.

Christopher McCormick1, Eric Hayes1, Valerie Hanlon2, Amanda Hustosky2, Freda White2; 1Respiratory Care, West Virginia University Hospitals, Morgantown, WV; 2Nursing, West Virginia University Hospitals, Morgantown, WV

Background: Trauma patients frequently display respiratory distress secondary to rib fractures, pulmonary contusions, pain and other consequences of traumatic injuries. Further respiratory complications can occur due to immobility, lack of deep breathing and poor pulmonary toilet. We hypothesize that not all trauma patients at risk for respiratory complications consistently receive focused care to prevent these complications that may result in transfer to higher intensity care settings. Increased attention to aggressive pulmonary preventive care may prevent respiratory complications, ultimately preventing unnecessary increases in length of stay and hospital incurred costs. Methods: Two pulmonary toilet order sets were created to be implemented with trauma patients on a pilot step-down unit at risk for developing respiratory complications: Standard and Aggressive (Table 1). Both respiratory care and nursing were educated about implementation of these order sets as a collaborative approach to ensure the full implementation of the developed protocols. After education, the protocol was implemented on patients upon receiving orders from the trauma physician. Results: After protocol implementation, the order set was initiated for 31 trauma patients with Injury Severity Scores (ISS) ranging from 16- 59 (Mean= 22). Of the 31 patients enrolled, 0 patients had an upgrade in care or transfer to ICU because of pulmonary complications. Data was also obtained for trauma patients (N= 41) who were not located in the study unit that had required an upgrade in care. It was found that 8 patients (ISS range= 5-29; Mean= 12) were upgraded for cardiopulmonary difficulties. Retrospective data for the prior year (N= 171) on the pilot unit with patients having similar ISS scores (>16) was also obtained. This reference data indicated 7 unplanned upgrades in care (4% occurrence rate) secondary to pulmonary complications. Conclusion: The implementation of the trauma pulmonary hygiene order sets provided beginning insight into the fact that focused pulmonary toilet interventions as a collaborative effort of Respiratory Care and Nursing staff may help to prevent respiratory complications and upgrades in care among trauma patients. Further data is needed to confirm this outcome. Sponsored Research - None Table 1