Presenter Status

Fellow

Abstract Type

QI

Primary Mentor

Joel Thompson

Start Date

6-5-2022 11:30 AM

End Date

6-5-2022 1:30 PM

Presentation Type

Poster Presentation

Description

Background: 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) provides specific recommendations for providing ten breaths of incentive spirometry (IS) every two hours while awake for patients with sickle cell disease to help prevent development of acute chest syndrome.

Problem Statement: We reviewed provision of incentive spirometry at Children’s Mercy between 08/01/2021 and 11/01/2021. Data was collected and the target population was identified via a report generated from the electronic medical records with specific criteria. Of those patients admitted with sickle cell-related complications, we reviewed the frequency that IS was offered each hospital day. We found that during that 3-month time period, no patients were offered IS at the frequency recommended by the NHLBI.

Aim Statement: The goal of this project is to increase the daily occurrences of IS offered to sickle cell patients admitted to the hospital with vaso-occlusive pain to meet the NHLBI recommended frequency from 0% to 10% over a 3-month period following the implementation of updated IS orders within Cerner powerplans.

PDSA Cycle Description: Meetings with stakeholders from nursing, respiratory therapy, and physicians identified that orders that nursing generated their tasks from were inconsistent between Cerner powerplans and were not based on current NHLBI recommendations as the root cause. Orders were updated to match NHLBI recommendations. Education on updated orders was provided to nursing staff and resident physicians rotating on the hematology/oncology team. We are currently collecting data on IS use during the 3 months following these interventions.

Results: Between 08/01/2021 and 11/01/2021, there were 285 hospital days with patients admitted to Children’s Mercy (CMH) with a sickle cell-associated diagnosis. We excluded 94 of these days to omit partial admission and discharge days from our data. Of 191 hospital days, only 53% (101/191) had IS documented at all. When IS was documented, 0% of patients were offered the recommended frequency of IS. When IS was documented, the median hours between IS was 6.3 hours. Following implementation of standardized IS orders on 12/21/21 we found that when IS was documented the median hours between when IS was offered decreased to 4.8 hours. We will continue to collect data through March 2022.

MeSH Keywords

Sickle cell disease; Incentive spirometry; acute chest syndrome

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May 6th, 11:30 AM May 6th, 1:30 PM

Increasing Incentive Spirometry Use in Patients with Sickle Cell Disease Admitted to Children’s Mercy Hospital

Background: 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) provides specific recommendations for providing ten breaths of incentive spirometry (IS) every two hours while awake for patients with sickle cell disease to help prevent development of acute chest syndrome.

Problem Statement: We reviewed provision of incentive spirometry at Children’s Mercy between 08/01/2021 and 11/01/2021. Data was collected and the target population was identified via a report generated from the electronic medical records with specific criteria. Of those patients admitted with sickle cell-related complications, we reviewed the frequency that IS was offered each hospital day. We found that during that 3-month time period, no patients were offered IS at the frequency recommended by the NHLBI.

Aim Statement: The goal of this project is to increase the daily occurrences of IS offered to sickle cell patients admitted to the hospital with vaso-occlusive pain to meet the NHLBI recommended frequency from 0% to 10% over a 3-month period following the implementation of updated IS orders within Cerner powerplans.

PDSA Cycle Description: Meetings with stakeholders from nursing, respiratory therapy, and physicians identified that orders that nursing generated their tasks from were inconsistent between Cerner powerplans and were not based on current NHLBI recommendations as the root cause. Orders were updated to match NHLBI recommendations. Education on updated orders was provided to nursing staff and resident physicians rotating on the hematology/oncology team. We are currently collecting data on IS use during the 3 months following these interventions.

Results: Between 08/01/2021 and 11/01/2021, there were 285 hospital days with patients admitted to Children’s Mercy (CMH) with a sickle cell-associated diagnosis. We excluded 94 of these days to omit partial admission and discharge days from our data. Of 191 hospital days, only 53% (101/191) had IS documented at all. When IS was documented, 0% of patients were offered the recommended frequency of IS. When IS was documented, the median hours between IS was 6.3 hours. Following implementation of standardized IS orders on 12/21/21 we found that when IS was documented the median hours between when IS was offered decreased to 4.8 hours. We will continue to collect data through March 2022.

 

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