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Comparative effectiveness of implementation of a nursing-driven protocol in reducing bronchodilator utilization for
Jamie M Pinto1, Janet L Schairer, Anna Petrova
1Department of Pediatrics, Jersey Shore University Medical Center, Neptune, New Jersey, USA.
Insights
A nursing-driven protocol significantly reduced bronchodilator use in hospitalized children with bronchiolitis. This highlights the benefits of nurse-led, evidence-based care for pediatric respiratory infections.
Area of Science:
- Pediatric Pulmonology
- Evidence-Based Medicine
- Nursing Practice
Background:
- Bronchiolitis is a common pediatric respiratory illness.
- Bronchodilator use in bronchiolitis is controversial and often not recommended.
- Standardized protocols can improve care consistency.
Purpose of the Study:
- To evaluate the impact of a nursing-driven protocol on bronchodilator administration in hospitalized children with bronchiolitis.
- To assess if nursing involvement influences adherence to evidence-based bronchiolitis management.
Main Methods:
- A retrospective study comparing 1-year periods before, during, and after protocol implementation.
- Inclusion criteria: children <2 years old hospitalized with bronchiolitis, without comorbidities.
- Statistical analysis included Chi-square, ANOVA, and regression (adjusted OR, 95% CI).
Main Results:
- Bronchodilator use decreased significantly from 70.0% before to 29.2% after protocol implementation (P < 0.0001).
- This reduction persisted after controlling for age and pneumonia (OR 0.68, 95% CI 0.61-0.79).
- Mean number of doses among treated patients was comparable across groups.
Conclusions:
- Implementation of a nursing-driven bronchiolitis protocol led to a significant reduction in initiating bronchodilator treatments.
- Nursing involvement in protocol implementation promotes evidence-based recommendations for pediatric bronchiolitis care.
- This approach demonstrates a potential benefit in optimizing treatment for hospitalized children with bronchiolitis.
Objective:
The goal of our study was to determine whether the administration of bronchodilators is affected by implementation of a nursing-driven protocol in the care of children hospitalized with bronchiolitis.
Methods:
We included children less than 2 years old, hospitalized with bronchiolitis, but without chronic lung problems, immunodeficiencies or congenital heart disease in the 1-year periods before, during and after implementation of a nursing-driven bronchiolitis protocol. The protocol is based on nursing assessments of respiratory status prior to initiation and continuation of bronchodilator therapy. Utilization rates of bronchodilators were compared with respect to implementation of the nursing-driven protocol using Chi-square, analysis of variance, and regression analysis that is presented as adjusted odds ratio (OR) and 95% confidence interval (95% CI) of the OR.
Results:
Among the 80 children who were hospitalized before, 63 during and 89 after the implementation of the nursing-driven bronchiolitis protocol, 70.0, 60.3, and 29.2%, respectively, received treatment with bronchodilators (P < 0.0001). Reduction in the use of bronchodilators in association with the implementation of the nursing-driven bronchiolitis protocol was also observed after controlling for the child's age and evidence of pneumonia (OR 0.68, 95% CI 0.61-0.79). The mean number of bronchodilator doses administered among patients in the three groups who received at least one treatment was comparable.
Conclusions:
Implementation of a nursing-driven bronchiolitis protocol was associated with significant reduction in initiation of bronchodilator treatments, which suggests a benefit from nursing involvement in the promotion of evidence-based recommendations in the management of children hospitalized with bronchiolitis.
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