Publication Date

5-2025

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Abstract

Acute chest syndrome is one of the leading causes of morbidity and mortality in patients with sickle cell disease. The National Heart, Lung, and Blood Institute (NHLBI) recommends that patients with sickle cell disease perform ten breaths of incentive spirometry (IS) every two hours while awake to prevent development of acute chest syndrome. By not meeting these guidelines, patients are more likely to develop this potentially life-threatening acute complication. To increase the use of IS in patients with sickle cell disease admitted to the hospital for vaso-occlusive pain. Patients were identified and IS occurrences were measured via review of electronic medical record. Of those patients admitted with sickle cell vaso-occlusive pain, the frequency that IS was offered or performed each hospital day was recorded. Partial admission and discharge days were excluded. For PDSA cycle 1, all IS orders in Cerner powerplans were updated to reflect current NHLBI recommendations. Additionally, education was provided to residents and nursing staff regarding the importance of the use of IS to prevent severe complications such as acute chest syndrome. Following PDSA cycle 1, a second meeting with stakeholders led to changing IS documentation to coincide with the required task of patient-controlled analgesia (PCA) assessment every two hours. Furthermore, as it is difficult for younger children to use IS appropriately, a new PCA form was created to document the use of alternatives to IS such as pinwheels or bubbles. Data obtained from 10/2023-12/2023 and 10/2024-12/2024 was then reviewed to evaluate the impact of PDSA cycle 2. From 8/2021-11/2021, there were 191 hospital days with patients admitted with sickle cell vaso-occlusive pain, of which 53% had IS documented. When IS was documented, 0% of patients received the recommended frequency of IS and the median hours between IS occurrences was 6.3 hours. From 12/2021-3/2022, 164 hospital days had IS documented 40% of the time with 2% of hospital days meeting the recommended frequency and 5.9 median hours between IS occurrences. From 8/2022-11/2022, 167 hospital days had IS documented 26% of the time with 12% of hospital days meeting the recommended frequency and 3.0 median hours between IS occurrences. From 10/2023 - 12/2023, 181 hospital days had IS documented 12.7% of the time with 9% of hospital days meeting the recommended frequency and 5.6 median hours between IS occurrences. From 10/2024 - 12/2024, 177 hospital days had IS documented 11% of the time with 15.7% of hospital days meeting the recommended frequency and 4.1 hours between IS occurrences. Implementation of uniform IS orders that match NHLBI recommendations resulted in an increase in the provision and frequency of IS used among the studied population. In PDSA cycle 2, implementation of IS documentation along with analgesia assessments resulted in an overall improvement of the median hours between IS occurrences and the number of hospital days with IS given at the recommended frequency, when IS was documented. It is important to note that the overall number of times in which IS was documented decreased compared to the first two cycles, however, the percentage of patients using IS at the recommended frequency continued to improve. For the next PDSA cycle, we will plan to address other potential barriers to IS documentation, such as accessibility to IS in the Hematology/Oncology inpatient unit . Further research will also focus on evaluating the impact of appropriate use of IS on the development of acute chest syndrome in our patient population.

Disciplines

Hematology | Pediatrics

Notes

Presented at American Society of Pediatric Hematology/Oncology (ASPHO) 2025 Conference; Louisville, KY; May 7-10, 2025.

Increasing incentive spirometry use in patients with sickle cell disease admitted to CMH

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