Implementation of a Nurse-Driven Asthma Pathway in the Pediatric Intensive Care Unit

Abstract

Background: Asthma is one of the most common conditions requiring admission to a pediatric intensive care unit. Dosing and weaning medications, particularly bronchodilators, are highly variable, and evidence-based weaning algorithms for clinicians are lacking in this setting. Methods: Patients admitted to a quaternary pediatric intensive care unit diagnosed with acute severe asthma were evaluated for time spent receiving continuous albuterol therapy, the length of stay in the intensive unit care unit, and the length of stay in the hospital. We developed an asthma pathway and continuous bronchodilator weaning algorithm to be used by bedside nurses. We then implemented two major Plan-Do-Study-Act cycles to facilitate the use of the pathway. They included implementing the algorithm and then integrating it as a clinical decision support tool in the electronic medical record. We used standard statistics and quality improvement methodology to analyze results. Results: One-hundred twenty-six patients met inclusion criteria during the study period, with 32 during baseline collection, 60 after weaning algorithm development and implementation, and 34 after clinical decision support implementation. Using quality improvement methodology, hours spent receiving continuous albuterol decreased from a mean of 43.6 to 28.6 hours after clinical decision support development. There were no differences in length of stay using standard statistics and QI methodology. Conclusion: Protocolized asthma management in the intensive care unit setting utilizing a multidisciplinary approach and clinical decision support tools for bedside nursing can reduce time spent receiving continuous albuterol and may lead to improved patient outcomes.

Improving Delirium Assessments in Vanderbilt Pediatric and Pediatric Cardiovascular Intensive Care Units

“…The significant role of EMR-based interventions in quality improvement in hospital settings in general, and ICU in particular, has been widely demonstrated. [16][17][18] This quality improvement project contributes to the existing literature by showing that one EMR-related intervention, introducing protocol flowsheets, improves compliance with delirium assessments. Future studies might focus on additional interventions that introduce newer automated systems into EMRs to aid healthcare professionals in conducting and documenting easily and efficiently.…”

Decreasing ICU and Hospital Length of Stay through a Standardized Respiratory Therapist-driven Electronic Clinical Care Pathway for Status Asthmaticus

“…Previous studies have established that guideline development can result in standardization, improvements in care, and, at times, decreased LOS. [11][12][13]15,16 Electronic clinical pathways have multiple standard functions and decision support for providers. 17 Different levels of decision support to providers impact patient care delivery, including customized order sets, best practice alerts (BPAs), reporting of variance, and tracking nursing, respiratory therapist, and pharmacist engagement.…”

“…Nursing and RT-driven weaning decrease hospital LOS in other studies. 5,12,22 Although order sets have impacted care delivery, our project would likely not have been successful if it solely relied on the order sets. 18 The SPC charts noted shifts in the weeks before the study interventions.…”

“…5,6 Several institutions have implemented objective scoring tools and a standardized approach to asthma care, including clinical pathways, electronic scoring tools, and order sets. 4–13 The electronic medical record (EMR) is a well-known tool for standardizing care. However, there is limited literature on its use to standardize care for patients with SA beyond scoring tools and order sets.…”

“…5,6 Several institutions have implemented objective scoring tools and a standardized approach to asthma care, including clinical pathways, electronic scoring tools, and order sets. [4][5][6][7][8][9][10][11][12][13] The electronic medical record (EMR) is a well-known tool for Introduction: Status asthmaticus (SA) is a cause of many pediatric hospitalizations. This study sought to evaluate how a standardized asthma care pathway (ACP) in the electronic medical record impacted the length of stay (LOS).…”