Objective
To determine the effect of an ED nurse-initiated asthma management protocol on door
to first salbutamol nebulization time.
Methods
This was a prospective before-after study. Asthmatics, aged 1 to 12 years presenting
to the ED with an exacerbation during the pre and post nurse-initiated care phases
(from 1/22/08 to 2/8/08 and from 2/12/08 to 3/4/08), were eligible. An asthma training
program was administered to nurses prior to post phase. Respiratory therapists started
the first nebulization after a physician order during the pre phase, whereas bedside
nurses initiated it before physician evaluation during the post phase. Mean differences
and confidence intervals (CI) were calculated.
Results
Each of the study groups had 125 patients. Door to first nebulization time was reduced
by a mean of 31.3 minutes (CI 23.0, 39.6) in the post phase. Door to steroids, second
nebulization, and bedside nurse evaluation time intervals were reduced by 22.8 minutes
(CI 8.8, 36.9), 21.7minutes (CI 9.1, 34.4) and 15.6 minutes (CI 7.5, 23.7) respectively.
Conclusion
An ED nurse-initiated asthma management protocol expedited initiation of medications
essential for relief of symptoms of acute asthma and bedside evaluation by nurses.
Standing nurse-initiated care protocols may proveto be beneficial in improving acute
asthma care in crowded EDs.
Key words
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Biography
Khajista Qazi is PEM Fellowship Director and Attending Physician, Pediatric Emergency Department, King Fahd Medical City, Riyadh, Saudi Arabia.
Biography
Saleh A. Altamimi is Attending Physician, Pediatric Emergency Department, and Chairman, Emergency Department, King Fahd Medical City, Riyadh, Saudi Arabia.
Biography
Hani Tamim is Associate Professor of Epidemiology and Biostatistics, King Abdullah International Medical Research Center, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
Biography
Khandee Serrano is Registered Nurse, Division of Pediatric Emergency Medicine, Department of Emergency Medicine, King Fahd Medical City, Riyadh, Saudi Arabia.
Article info
Publication history
Published online: December 23, 2009
Accepted:
November 5,
2009
Received in revised form:
October 17,
2009
Received:
July 12,
2009
Identification
Copyright
© 2010 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.
