Implementing a Respiratory Therapist-Driven Continuous Albuterol Weaning Protocol in the Pediatric ICU
Danielle K Maue1, Alvaro J Tori2, Andrew L Beardsley2
1Department of Pediatrics, Division of Critical Care Medicine, Indiana University School of Medicine/Riley Hospital for Children at IU Health, Indianapolis, IN. dmaue@iu.edu.
Insights
A new protocol for respiratory therapists to wean continuous albuterol in pediatric asthma patients was implemented. This quality improvement initiative successfully reduced albuterol duration without increasing adverse events or length of stay.
Area of Science:
- Pediatric critical care medicine
- Respiratory therapy
- Asthma management
Background:
- Status asthmaticus is a common pediatric intensive care unit (PICU) admission.
- Effective collaboration between respiratory therapists (RTs) and physicians is crucial for managing status asthmaticus.
- The Pediatric Asthma Severity Score (PASS) quantifies asthma exacerbation severity.
Purpose of the Study:
- To implement an RT-driven continuous albuterol weaning protocol using the PASS score.
- To evaluate the protocol's impact on the duration of continuous albuterol.
- To assess for any increase in adverse events associated with the new protocol.
Main Methods:
- A single-center implementation study in a pediatric ICU.
- Inclusion of patients with status asthmaticus receiving continuous albuterol.
- Development of an interdisciplinary protocol, order sets, and staff education.
- RTs assessed patients using the PASS score to guide albuterol dose adjustments.
Main Results:
- Compared 104 pre-protocol subjects to 117 post-protocol subjects.
- No significant change in the median duration of continuous albuterol (12.1h vs. 11.1h, P=.22).
- No significant change in median PICU length of stay (19.5h vs. 23.2h, P=.16).
- No increase in adverse events observed.
Conclusions:
- An interprofessionally developed, RT-driven continuous albuterol weaning protocol is feasible.
- Implementation did not negatively impact continuous albuterol duration or PICU length of stay.
- The protocol can be safely implemented without increasing adverse events.
Background:
Status asthmaticus is one of the most frequent admission diagnoses in the pediatric ICU (PICU). Collaboration between respiratory therapists (RTs) and physicians may help efficiently deliver care to a patient in status asthmaticus. The Pediatric Asthma Severity Score (PASS) is a measure of severity of a patient's asthma exacerbation at a point in time. The aim of this quality improvement initiative was to establish an RT-driven continuous albuterol weaning protocol using the PASS score. We hypothesized that this would decrease the duration of continuous albuterol without increasing adverse events.
Methods:
This was a single-center implementation study in the PICU of a quaternary care children's hospital. Patients with a diagnosis of status asthmaticus who met criteria on continuous albuterol between September 2015 and September 2017 were included. An interdisciplinary team established the protocol, order sets, documentation, and education for involved staff. Qualifying subjects were assessed by an RT per protocol and assigned a PASS score, and the albuterol dose was adjusted on the basis of the PASS score.
Results:
We compared 104 subjects studied before the implementation of this protocol (September 2015 to August 2016) to 117 subjects after the implementation of this protocol (September 2016 to October 2017). Median (interquartile range) duration of continuous albuterol in the PICU post-implementation was unchanged compared to pre-implementation: 12.1 (7.2-21.0) h versus 11.1 (6-19) h (P = .22). Median PICU length of stay was also unchanged post-implementation compared to pre-implementation: 19.5 (14.3-29.7) h versus 23.2 (15.2-31.3) h (P = .16). Using control charts, these processes were stable. There was no difference in adverse events.
Conclusions:
An interprofessionally-developed, RT-driven continuous albuterol weaning protocol can be implemented without negatively impacting duration of continuous albuterol or PICU length of stay and without increasing adverse events.
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