Implementation of a ß-Agonist/Airway Clearance Protocol in a Pediatric ICU.
Respir Care
; 62(3): 259-267, 2017 Mar.
Article
en En
| MEDLINE
| ID: mdl-28028189
ABSTRACT
BACKGROUND:
Respiratory therapist (RT)-driven protocols have been in use for over 30 years. Protocols have been reported to decrease unnecessary or harmful therapy, health-care costs, and hospital stay. This study represents the evaluation of an original respiratory care protocol in the pediatric ICU at Arkansas Children's Hospital for ß-agonist and airway clearance interventions where one did not exist.METHODS:
This project was composed of 2 parts a survey administered to RTs and licensed independent practitioners and a retrospective review of outcome data comparing a therapist-driven ß-agonist/airway clearance protocol with physician-directed respiratory care ordering in a patient population admitted for acute respiratory failure.RESULTS:
Acceptance of the protocol was evident in the survey responses because overall perceptions surrounding the implementation of the ß-agonist/airway clearance protocol were positive, and responders perceived that the protocol implementation elevated the status and increased the value of respiratory therapists. For the comparison of physician-directed orders with therapist-driven protocols, there were no significant differences between pre- and post-intervention groups for mean age, sex, mean daily acuity, or mean weighted daily acuity (P = .33, .19, >.99, and .79, respectively). There were also no differences in pediatric index of mortality 2, pediatric index of mortality 2 rate of mortality, pediatric risk of mortality 3 probability of death, and pediatric risk of mortality 3 scores (P = .63, .56, .19, and .44, respectively) between the 2 groups. When comparing physician-directed orders to therapist-driven protocols, all outcome measures (length of stay, ß-agonist therapies, airway clearance therapies, and ventilator days) showed statistically and clinically important reductions, adjusting for subject characteristics (P < .001) for the therapist-driven protocol group.CONCLUSIONS:
In this institution, implementation of a ß-agonist/airway clearance protocol resulted in significant reductions of subject interventions and improved outcomes by decreasing length of stay and ventilator days as well as contributing information where clinical evidence is scant, specifically the pediatric ICU.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Insuficiencia Respiratoria
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Terapia Respiratoria
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Unidades de Cuidado Intensivo Pediátrico
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Protocolos Clínicos
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Implementación de Plan de Salud
Tipo de estudio:
Guideline
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Observational_studies
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Risk_factors_studies
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Sysrev_observational_studies
Aspecto:
Implementation_research
Límite:
Child
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Child, preschool
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Female
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Humans
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Male
Idioma:
En
Revista:
Respir Care
Año:
2017
Tipo del documento:
Article
Pais de publicación:
EEUU
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ESTADOS UNIDOS
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ESTADOS UNIDOS DA AMERICA
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EUA
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UNITED STATES
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UNITED STATES OF AMERICA
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US
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USA