To determine the effect of an ED nurse-initiated asthma management protocol on door to first salbutamol nebulization time.
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.
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.
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.
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- Effect of emergency department crowding on time to antibiotics in patients admitted with community-acquired pneumonia.Ann Emerg Med. 2007; 50: 501-509
- Emergency department crowding is associated with poor pain care for patients with severe pain.Ann Emerg Med. 2008; 51: 1-5
- The effect of emergency department crowding on clinically oriented outcomes.Acad Emerg Med. 2009; 16: 1-10
- The efficiency of structured assessment and analgesia provision in the pediatric emergency department.Emerg Med J. 2005; 22: 30-32
- A prospective study of Panadein Forte: expanding pain management in the ED.Accid Emerg Nurs. 2004; 12: 136-140
- Nurse-initiated intravenous morphine in the emergency department: efficacy, rate of adverse events and impact on time to analgesia.Emerg Med. 2002; 14: 249-254
- Reducing pediatric pain during ED procedures with a nurse-driven protocol: an urban pediatric emergency department's experience.J Emerg Nurs. 2003; 29: 127-132
- Early intervention for the pneumonia patients: an emergency department triage protocol.J Emerg Nurs. 2006; 32: 154-158
- Nurse triage, diagnosis and treatment of eye casualty patients: a study of quality and utility.Accid Emerg Nurs. 2003; 11: 226-228
- Guidelines for diagnosis and management of asthma.(Available at:)Accessed July 12, 2009)
- Controlled trial of oral prednisone in the emergency department: treatment of children with acute asthma.Pediatrics. 1993; 4: 513-518
- Nebulized dexamethasone versus oral prednisone in the emergency department: treatment of asthmatic children.Ann Emerg Med. 1995; 26: 480-486
- A randomized trial of magnesium in the emergency department: treatment of children with asthma.Ann Emerg Med. 2000; 36: 572-578
Khajista Qazi is PEM Fellowship Director and Attending Physician, Pediatric Emergency Department, King Fahd Medical City, Riyadh, Saudi Arabia.
Saleh A. Altamimi is Attending Physician, Pediatric Emergency Department, and Chairman, Emergency Department, King Fahd Medical City, Riyadh, Saudi Arabia.
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.
Khandee Serrano is Registered Nurse, Division of Pediatric Emergency Medicine, Department of Emergency Medicine, King Fahd Medical City, Riyadh, Saudi Arabia.
Published online: December 23, 2009
Accepted: November 5, 2009
Received in revised form: October 17, 2009
Received: July 12, 2009
© 2010 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.