Evaluation of a Nursing Educational Intervention on the Proper Technique for Incentive Spirometry in Post-operative and Trauma Critical Care Patients - PowerPoint PPT Presentation

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Evaluation of a Nursing Educational Intervention on the Proper Technique for Incentive Spirometry in Post-operative and Trauma Critical Care Patients

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Evaluation of a Nursing Educational Intervention on the Proper Technique for Incentive Spirometry in Post-operative and Trauma Critical Care Patients – PowerPoint PPT presentation

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Title: Evaluation of a Nursing Educational Intervention on the Proper Technique for Incentive Spirometry in Post-operative and Trauma Critical Care Patients


1
Evaluation of a Nursing Educational Intervention
on the Proper Technique for Incentive
Spirometry in Post-operative and Trauma Critical
Care Patients
  • Sara Couch, RN,BSN,CCRN - EBPI fellow
  • Laura Dibsie, RN, MSN,CCRN - EBPI mentor
  • UCSD Medical Center

2
Recognition
  • Financial and Logistical Support
  • Juana Burkhart, RN, BSN, CCRN - SICU manager
  • Mary Hackim, RN, MS Director, EDR
  • UCSD Department of Nursing
  • Team members
  • Sue Wynn, Informatics Nurse
  • Caroline Brown, RN, PhD. - Facilitator
  • Helen Ogg, SICU Clinical Nurse Educator
  • Mary Wickline, Librarian
  • Julie Emerick, RT
  • All SICU staff for their patience and
    participation!!

3
The Catalyst
  • Need to understand and improve nursing role in
    care and outcome of SCI patients.
  • RNs had inconsistent understanding and practice
    related to pulmonary management of SCI patients
  • Desire to complete CNIII promotional process.

4
Significance
  • SCI patients are often associated with a sudden
    and tragic lifestyle change, this can be further
    complicated by pulmonary issues during recovery.
  • Responding to staff and patient concerns related
    to patient plan of care and desire to improve
    patient outcome.

5
PICO question
  • Population UCSD, SICU RNs and RTs
  • Intervention Implementation of an education
    program about incentive spirometry
  • Comparison Knowledge and documentation of IS
    practice with non-ventilated trauma and
    post-surgical patients.
  • Outcome Improved scores in post-education
    knowledge assessment and improved documentation

6
The Evidence
  • No Gold Standard for acute pulmonary care of
    SCI patients.
  • Limited literature available.
  • In the literature, inspiratory muscle training
    (IMT) is consistently associated with improved
    patient outcome.
  • Incentive spirometry is an effective IMT therapy.

7
Applying Project Design
  • IRB application submitted June 2007
  • Revisions and approval July 2007
  • 5 week study design including
  • Pre-test and chart audit
  • Live education to staff
  • Post-test and chart audit
  • Data analysis

8
Methods Procedure
  • Human subject approval 071124X
  • Recruitment
  • IRB approved email and staff meeting
    announcements, including informed consent info
  • Verbal consent at time of education
  • Data collection
  • EMTEK query
  • Pre-tests available 14 days
  • Education 10 sessions/8 days (3 week span) with
    post test completion
  • EMTEK query

9
Methods Instruments
  • Knowledge Test
  • IRB approved
  • Brief
  • Multiple choice
  • Focused on EBP found in literature review
  • Same instrument used pre- and post-test
  • Chart query
  • 3-week time frame pre- and post-education
  • All non-ventilated SICU patients

10
Sample and Setting
  • Convenience sample of SICU RNs and RTs
  • Day and night shift career, per diem, or
    temporary/contract
  • Varied experience
  • Either gender
  • Pre-test n 46
  • Post-test n 40 (5 RTs)
  • Education sessions primarily in Surgical/Trauma
    ICU of academic medical center in large
    metropolitan area

11
Findings Pre/Post
  • Nurses knowledge improved with education
  • Knowledge of most effective treatment time more
    than doubled (almost 100)
  • Pre-test About half the nurses understood
    differences in terminology between IS breath
    (Vital Capacity) and resting breath (Tidal
    Volume)
  • Post-test this improved to more than
    three-quarters

12
Greatest Improvement
What 3 factors determine pts goal volume?
24
88
13
Most correct answers
How long should pt hold breath?
48
98
14
Most Commonly MissedPre Post
Incentive spirometry measures what?
78
48
50
20
15
Documentation Pre-
  • Pre-education documentation was inconsistent
  • Two options Done or Active
  • Comments not detailed
  • attempted
  • UTA
  • CDB
  • 10 x 1000

16
Documentation Post-
  • Definitely more detailed
  • Patients effort now documented
  • Computer charting that prompts intervention
  • Includes target volume (to trigger RN)

17
New Charting
18
Similarities / Unchanged
  • Some patients, including those on room air, have
    no documentation for IS therapy
  • No standard for frequency of charting IS
    treatment

19
Advancing and Adopting
  • Laminate target volume insert information and
    post in supply area
  • Follow up on obtaining insert info in several
    languages for patient and family
  • Fellow follow-up with staff and SCI patients
  • Summarize key findings on Hot Topics Bulletin
    Board
  • Incorporate findings into standards of care

20
Lessons Learned
  • Clinical Project/Information
  • Not the anticipated focus from initial
    application, but greater appreciation and
    understanding IMT using IS.
  • EBPI Experience
  • Where we started vs. where we ended up
  • Empowered to ask questions and challenge current
    practice
  • Tools to research and investigate the answers
  • More critical of practice and literature
  • Appreciate constant presence of opportunities for
    improvement

21
Select References
  • Royster, R.A., Barboi, C., Peruzzi, W.T.
    (2004). Critical care in the acute cervical
    spinal cord injury. Topics in Spinal Cord Injury
    Rehabilitation, 9(3), 11 32.
  • Agency for Healthcare Research Quality. (2001).
    Treatment of pulmonary disease following cervical
    spinal cord injury. Summary, evidence
    report/technology assessment number 27 (AHRQ
    Publication No. 01-E013). Retrieved February 13,
    2007 from http//www.ahrq.gov/clinic/epcsums/spin
    alsum/htm
  • AARC Clinical Practice Guideline Incentive
    Spirometry. Retrieved April 5, 2007 from
    http//www.rcjournal.com/cpgs/ispircpg.html

22
For additional information please contact
  • Sara Couch scouch_at_ucsd.edu
  • Laura Dibsie ldibsie_at_ucsd.edu
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