Impact of an Emergency Nurse–Initiated Asthma Management Protocol on Door-to-First-Salbutamol-Nebulization-Time in a Pediatric Emergency Department

Qazi, Khajista; Altamimi, Saleh; Tamim, Hani; Serrano, Khandee

doi:10.1016/j.jen.2009.11.003

Cited by 18 publications

(7 citation statements)

References 12 publications

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“…Our results are consistent with those of Qazi et al, 10 who found that time to first salbutamol administration (mean of 31 min) and time to corticosteroid administration improved after their emergency department implemented a nurseinitiated protocol. Similar to our study, Qazi et al failed to find a reduction in emergency department length of stay despite earlier implementation of appropriate rescue medications.…”

Section: Discussionsupporting

confidence: 92%

An Asthma Protocol Improved Adherence to Evidence-Based Guidelines for Pediatric Subjects With Status Asthmaticus in the Emergency Department

Miller¹,

Breslin

Pineda

et al. 2015

Respir Care

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BACKGROUND: In our institution's pediatric emergency department, adherence to evidencebased asthma guidelines was noted to be suboptimal for patients with asthma exacerbations. We hypothesized that an evidence-based asthma protocol would improve time to treatment and adherence to National Institutes of Health guidelines for patients presenting to the emergency department with status asthmaticus. METHODS: Subjects at our institution were retrospectively identified through an electronic medical record search following institutional review board approval. The asthma protocol was initiated in February 2012. All pediatric subjects who received continuous albuterol in the emergency department before (February 26, 2009, to February 22, 2012, n ‫؍‬ 193) and after (February 23, 2012, to December 31, 2012, n ‫؍‬ 68) protocol initiation were analyzed. The post-protocol data were collected as part of routine quality assurance monitoring with a target of 60 post-protocol subjects. Subjects were identified at the end of each month, which resulted in a total of 68 subjects being included. Primary outcomes measured included time to initial treatment with inhaled bronchodilator therapy, time to treatment with systemic corticosteroids, and total number of ipratropium bromide treatments delivered. RESULTS: Two-hundred sixty-one subjects (7.1 ؎ 4.6 y of age, 66% male) were included. Demographics were similar in the pre-and postprotocol groups. Compared with the pre-protocol group, more subjects in the post-protocol group received bronchodilators within 30 min (60% vs 77%, P ‫؍‬ .02), at least one dose of ipratropium bromide (55% vs 87%, P < .001), 3 doses of ipratropium bromide (14% vs 54%, P < .001), and corticosteroids within 60 min (62% vs 77%, P ‫؍‬ .04). There were no statistically significant differences between the pre-and post-protocol cohorts in the mean time to first bronchodilator treatment (32 ؎ 41 vs 26 ؎ 52 min, P ‫؍‬ .34), mean time to corticosteroid administration (74 ؎ 68 vs 54 ؎ 63 min, P ‫؍‬ .06), or mean emergency department length of stay (342 ؎ 143 vs 364 ؎ 183 min, P ‫؍‬ .31). CONCLUSIONS: An asthma protocol resulted in improved adherence to National Institutes of Health guidelines in children with status asthmaticus and improved efficiency in the administration of rescue bronchodilator and systemic corticosteroid therapy.

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Section: Discussionsupporting

confidence: 92%

An Asthma Protocol Improved Adherence to Evidence-Based Guidelines for Pediatric Subjects With Status Asthmaticus in the Emergency Department

Miller¹,

Breslin

Pineda

et al. 2015

Respir Care

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“…Time to these interventions at our institution in the control period was already substantially less than in Wolff 's study intervention period, likely reflecting the use of verbal orders. ED overcrowding may lead to delayed treatment and prolonged ED LOS (6). Despite a 3.9% increase in patient census at our institution over the study period (with no concomitant increase in staffing), our time to serum bilirubin sampling and phototherapy initiation improved with the use of the management protocol.…”

Section: Discussionmentioning

confidence: 98%

“…Clinical pathways operationalize best evidence guidelines into accessible bedside formats for health care provider teams (5). Management protocols, also known as standing orders or medical directives, further improve the effectiveness of clinical pathways by delegating authority for nonphysician implementers to perform designated actions prior to physician assessment, thus facilitating timely care (6). Studies evaluating PED nurse-initiated clinical pathways and management protocols have demonstrated significant outcome improvements for acutely ill patients (5,(7)(8)(9).…”

mentioning

confidence: 99%

A nurse-initiated jaundice management protocol improves quality of care in the paediatric emergency department

Long

Farion

Zemek

et al. 2017

Paediatrics &Amp; Child Health

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“…These studies describe improvements in several aspects of patient care outcomes as a result of nurse-initiated care, including regulation of blood glucose [12–15], reduction in length of intubation [16, 17], reduction in the need for physical restraint [18], improved pain control [19, 20], improved outcome for myocardial infarction patients [21, 22], reduction in the number of catheter-associated urinary tract infections [23], and reduction in time to first treatment for asthmatic patients [24, 25]. For example, in their 2007 article, Wong et al report “triage nurse-initiated pain relief has been evident as an effective measure for pain management” [26].…”

Section: Nurse-initiated Protocolsmentioning

confidence: 99%

Advanced Nursing Directives: Integrating Validated Clinical Scoring Systems into Nursing Care in the Pediatric Emergency Department

deForest

Thompson

2012

Nursing Research and Practice

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In an effort to improve the quality and flow of care provided to children presenting to the emergency department the implementation of nurse-initiated protocols is on the rise. We review the current literature on nurse-initiated protocols, validated emergency department clinical scoring systems, and the merging of the two to create Advanced Nursing Directives (ANDs). The process of developing a clinical pathway for children presenting to our pediatric emergency department (PED) with suspected appendicitis will be used to demonstrate the successful integration of validated clinical scoring systems into practice through the use of Advanced Nursing Directives. Finally, examples of 2 other Advanced Nursing Directives for common clinical PED presentations will be provided.

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Impact of an Emergency Nurse–Initiated Asthma Management Protocol on Door-to-First-Salbutamol-Nebulization-Time in a Pediatric Emergency Department

Cited by 18 publications

References 12 publications

An Asthma Protocol Improved Adherence to Evidence-Based Guidelines for Pediatric Subjects With Status Asthmaticus in the Emergency Department

An Asthma Protocol Improved Adherence to Evidence-Based Guidelines for Pediatric Subjects With Status Asthmaticus in the Emergency Department

A nurse-initiated jaundice management protocol improves quality of care in the paediatric emergency department

Advanced Nursing Directives: Integrating Validated Clinical Scoring Systems into Nursing Care in the Pediatric Emergency Department

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