Exploring the effectiveness of ED nurse-initiated asthma protocol : optimizing the clinical outcomes

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Exploring the effectiveness of ED nurse-initiated asthma protocol : optimizing the clinical outcomes


Author: Wong, Lai-fan Mirada
Title: Exploring the effectiveness of ED nurse-initiated asthma protocol : optimizing the clinical outcomes
Degree: M.Sc.
Year: 2008
Subject: Hong Kong Polytechnic University -- Dissertations.
Emergency nursing.
Asthma -- Treatment.
Department: School of Nursing
Pages: viii, 74 leaves : col. ill. ; 30 cm.
Language: English
InnoPac Record: http://library.polyu.edu.hk/record=b2232402
URI: http://theses.lib.polyu.edu.hk/handle/200/3485
Abstract: Background: Asthma exacerbation commonly necessitates a visit to an emergency department (ED), however under traditional physician-initiated treatment (PIT), patients with acute asthmatic attack are not given any bronchodilator treatment without physician's prescription. With regards to the progressively prolonged waiting time for physician consultation in ED, asthmatic patients were at risks of deteriorating condition during their stay in the waiting area. A "Nurse-initiated Asthma Protocol" (NIAP) was then put into practice trying to address this issue in April 2006. This study was aimed to evaluate the impact of NIAP and compare the effectiveness on patients' clinical outcomes, number of bronchodilator treatment received, waiting time prior to initial bronchodilators treatment and the number of hospital admission among asthmatic patients with and without the activation of NIAP. Methods: A descriptive, retrospective, case-control study with a recruitment of 120 asthmatic patients who sought acute asthma care in the venue understudied. Adult patients who met the inclusion criteria were eligible, in which, the cases referred to those received NIAP treatment and for those received ordinary PIT were the controls. All subjects were identified from the Clinical Data Analysis and Reporting System (CDARS), and the data were obtained by reviewing the ED clinical records retrieved from the Accident and Emergency Information System (AEIS). Chi-square tests and Mann-Whitney U-test were used for comparing differences in the demographic characteristics, and one way ANOVA was used to analyze the variance associations. Pearson Product-moment correlation coefficient was used to measure the strength of association between variables as appropriate. Results: The NIAP group demonstrated significant higher improvement rate of PFR (54.3% +- 2.99%) than the PIT group (22.41% +- 7.534) in Cat.3 subjects (p=0.034, Mann-Whitney), and the same result was found in those less urgent clients when figures showing NIAP group (51.36% +- 7.315%) and PIT (28.3% +- 8.388%) in Cat. 4 subjects(p=0.213, Mann-Whitney) respectively. There was no significant difference concerning the mode of disposal in PIT group and NIAP group among subjects under Cat. 3 (p=0.386, Mann-Whitney) and Cat. 4 (p=0.250, Mann-Whitney) respectively. In which more NIAP subjects (n=38, 63.3%) in comparison to PIT subjects (n=29, 48.3%) were discharged home whilst more PIT subjects (n=24, 40%) were admitted to Observation ward than the those of NIAP group (n=15, 25%). There were minimal difference in the admission rate to the medical ward NIAP subjects (n=4, 6.7%) and PIT subjects (n=5, 8.3%) respectively. The NIAP group was significantly more often required second dose of bronchodilator tieatment than PIT group among Cat. 3 subjects (p=0.008, Mann-Whitney). The mean waiting time for initial bronchodilators tieatment in Cat.3 and Cat.4 NIAP subjects were 13.63 +- SD7.707 minutes and 16.76 +- SD11.189 minutes respectively. The waiting time was significantly shorter than those in the PIT group with 29.07 minutes +- SD15.564 and 94.88 +- SD72.964 minutes (p<0.001, Mann-Whitney) among Cat.3 and Cat.4 respectively. Conclusion: The NIAP was effective and safe in improving the respiratory conditions by demonstrating significant improvement of PFR by as much as twofold in comparison to the result based on the traditional PIT model. There is a marked reduction of waiting time for the initial bronchodilator tieatment when it is noted of amazingly controlling the symptoms which possibly reducing the risks of deteriorating respiratory condition due to prolonged waiting. The untimely intervention has a positive impact to asthma patients which consequently bring benefits to both patients and the healthcare providers.

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