Impoving Asthma Outcomes: Decreasing Door-to-Steroid Time in Moderate/Severe Asthma Patients

2.50
Hdl Handle:
http://hdl.handle.net/10755/162570
Type:
Presentation
Title:
Impoving Asthma Outcomes: Decreasing Door-to-Steroid Time in Moderate/Severe Asthma Patients
Abstract:
Impoving Asthma Outcomes: Decreasing Door-to-Steroid Time in Moderate/Severe Asthma Patients
Conference Sponsor:Emergency Nurses Association
Conference Year:2010
Author:Kingsnorth, Jennifer, RN, MSN
P.I. Institution Name:Children's National Medical Center
Title:Professional Practice Specialist
Contact Address:111 Michigan Avenue NW, Washington, DC, 20010, USA
Contact Telephone:202-476-3683
Co-Authors:Kathy Brown, MD
Leadership Conference - Evidence-Based Practice Abstract: Improving Asthma Outcomes: Decreasing Door to Steroid Time in
Moderate/Severe Asthma Patients


Purpose: Asthma is a prevalent diagnosis in pediatric emergency departments. The NIH: National Heart, Lung, and Blood Institute recommend steroid administration within 60 minutes of entry to ED care, to decrease bronchial edema, promoting positive patient outcomes. Steroids affect the edematous bronchial tissue, providing patientsÆ relief from asthma exacerbation versus the short term affect of inhaled bronchiodilators. Administration of steroids within 60 minutes of ED entry will allow for a decrease in bronchiodilators, decrease LOS and decrease admissions.

Design: This evidence based practice initiative is a nurse sensitive quality improvement project.

Setting: A pediatric emergency department in the Mid-Atlantic region serving over 80,000 patients per year, with approximately 8,000 patients presenting with asthma related illness.

Participants/Subjects: Pediatric patients age 1 -18 years with known asthma presenting with respiratory symptoms categorized as moderate or severe were place on the asthma pathway.

Methods: Step One to meeting the goal included aggregating the asthma population to a specific area of the ED. Aggregation of the population allows the health care team to provide systematic care and have the asthma patient's assessment and reassessment as a focus. Concurrently the team worked to develop an evidence-based pathway for moderate/severe asthma patients. The pathway allows care to be initiated upon identification of the patient meeting inclusion criteria (asthma score <4), decreasing delays in treatment. Nursing and physician staff were educated via in-services, posters, e-mails and 1:1 discussion to the importance of steroid initiation. Monthly data was shared with staff. Continuing education based on monthly data occurred to assure knowledge of asthma care and compliance with steroid administration.

Results/Outcomes: The 60 minute goal was achieved August 2007. Due to the intervention's success the the arrival-to-steroid goal decreased to 45 minutes in October 2007. The July 09 average door to steroid time is 42. Random nursing survey indicates steroid administration and pathway initiation is culture in the ED.

Implications: Implementation of pathways to initiate care in addition to aggregation of like patients increase efficiency and safety of patients. Assuring moderate/severe asthma patients steroid administration increases positive outcome, and decrease asthma admissions.

Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleImpoving Asthma Outcomes: Decreasing Door-to-Steroid Time in Moderate/Severe Asthma Patientsen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162570-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Impoving Asthma Outcomes: Decreasing Door-to-Steroid Time in Moderate/Severe Asthma Patients</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2010</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Kingsnorth, Jennifer, RN, MSN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Children's National Medical Center</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Professional Practice Specialist</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">111 Michigan Avenue NW, Washington, DC, 20010, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">202-476-3683</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">jhinrich@cnmc.org</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Kathy Brown, MD</td></tr><tr><td colspan="2" class="item-abstract">Leadership Conference - Evidence-Based Practice Abstract: Improving Asthma Outcomes: Decreasing Door to Steroid Time in <br/>Moderate/Severe Asthma Patients<br/><br/><br/>Purpose: Asthma is a prevalent diagnosis in pediatric emergency departments. The NIH: National Heart, Lung, and Blood Institute recommend steroid administration within 60 minutes of entry to ED care, to decrease bronchial edema, promoting positive patient outcomes. Steroids affect the edematous bronchial tissue, providing patients&AElig; relief from asthma exacerbation versus the short term affect of inhaled bronchiodilators. Administration of steroids within 60 minutes of ED entry will allow for a decrease in bronchiodilators, decrease LOS and decrease admissions.<br/><br/>Design: This evidence based practice initiative is a nurse sensitive quality improvement project.<br/><br/>Setting: A pediatric emergency department in the Mid-Atlantic region serving over 80,000 patients per year, with approximately 8,000 patients presenting with asthma related illness. <br/><br/>Participants/Subjects: Pediatric patients age 1 -18 years with known asthma presenting with respiratory symptoms categorized as moderate or severe were place on the asthma pathway. <br/><br/>Methods: Step One to meeting the goal included aggregating the asthma population to a specific area of the ED. Aggregation of the population allows the health care team to provide systematic care and have the asthma patient's assessment and reassessment as a focus. Concurrently the team worked to develop an evidence-based pathway for moderate/severe asthma patients. The pathway allows care to be initiated upon identification of the patient meeting inclusion criteria (asthma score &lt;4), decreasing delays in treatment. Nursing and physician staff were educated via in-services, posters, e-mails and 1:1 discussion to the importance of steroid initiation. Monthly data was shared with staff. Continuing education based on monthly data occurred to assure knowledge of asthma care and compliance with steroid administration.<br/><br/>Results/Outcomes: The 60 minute goal was achieved August 2007. Due to the intervention's success the the arrival-to-steroid goal decreased to 45 minutes in October 2007. The July 09 average door to steroid time is 42. Random nursing survey indicates steroid administration and pathway initiation is culture in the ED.<br/><br/>Implications: Implementation of pathways to initiate care in addition to aggregation of like patients increase efficiency and safety of patients. Assuring moderate/severe asthma patients steroid administration increases positive outcome, and decrease asthma admissions.<br/><br/></td></tr></table>en_GB
dc.date.available2011-10-27T10:30:25Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:30:25Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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