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Comparative effectiveness of implementation of a nursing‐driven protocol in reducing bronchodilator utilization for hospitalized children with bronchiolitis
Author(s) -
Pinto Jamie M.,
Schairer Janet L.,
Petrova Anna
Publication year - 2014
Publication title -
journal of evaluation in clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.737
H-Index - 73
eISSN - 1365-2753
pISSN - 1356-1294
DOI - 10.1111/jep.12121
Subject(s) - bronchiolitis , medicine , bronchodilator , odds ratio , confidence interval , bronchodilator agents , intensive care medicine , emergency medicine , nursing , pediatrics , asthma , respiratory system
Objective The goal of our study was to determine whether the administration of bronchodilators is affected by implementation of a nursing‐driven protocol in the care of children hospitalized with bronchiolitis. Methods We included c hildren less than 2 years old, hospitalized with bronchiolitis, but without chronic lung problems, immunodeficiencies or congenital heart disease in the 1‐year periods before, during and after implementation of a nursing‐driven bronchiolitis protocol. The protocol is based on nursing assessments of respiratory status prior to initiation and continuation of bronchodilator therapy. Utilization rates of bronchodilators were compared with respect to implementation of the nursing‐driven protocol using C hi‐square, analysis of variance, and regression analysis that is presented as adjusted odds ratio ( OR ) and 95% confidence interval (95% CI ) of the OR . Results Among the 80 children who were hospitalized before, 63 during and 89 after the implementation of the nursing‐driven bronchiolitis protocol, 70.0, 60.3, and 29.2%, respectively, received treatment with bronchodilators ( P < 0.0001). Reduction in the use of bronchodilators in association with the implementation of the nursing‐driven bronchiolitis protocol was also observed after controlling for the child's age and evidence of pneumonia ( OR 0.68, 95% CI 0.61–0.79). The mean number of bronchodilator doses administered among patients in the three groups who received at least one treatment was comparable. Conclusions Implementation of a nursing‐driven bronchiolitis protocol was associated with significant reduction in initiation of bronchodilator treatments, which suggests a benefit from nursing involvement in the promotion of evidence‐based recommendations in the management of children hospitalized with bronchiolitis.