The Impact of Implementing a Nursing-driven Clinical Pathway for Inpatient Management of Children With Asthma (NAP)
Asthma is the most common chronic disease of childhood and is responsible for large portion of pediatric admissions to Canadian hospitals. There is evidence that clinical pathways allow for optimal delivery of care and may result in decreased length of stay, leading to important economic benefits. Weaning of asthma medications prescribed for asthma exacerbation is not standardized in the current model of care. Currently, weaning is performed by ward physicians; in a teaching hospital, this most often done by residents staff. Differences in practice between different physicians, delays in patient assessment and adjustment of doctor's orders, likely prolong the hospital stay for children admitted with asthma.
This study's main objective is to determine the effect of a nursing-driven clinical pathway on children's length of stay when admitted to hospital with a diagnosis of acute asthma exacerbation. The pathway will allow nurses to wean a specific type of medication(β2-agonist), as compared to the current standard of care, which dictates that a physician writes an order to wean the medication. Number of administered β2-agonist treatments will be compared between both groups, as well as asthma-related health care utilization within two weeks of hospital discharge. Nursing, physician, and patients' satisfaction with the pathway will be evaluated, and a cost minimization analysis will be performed.
This study has the potential to improve resource use efficiency, increase patient safety by avoiding administration of unnecessary medications, and ameliorate quality of care by standardizing the care of children admitted to the hospital with a diagnosis of acute asthma exacerbation. The results of the study will be disseminated across the Canadian Health Care System with the goal of improving outcomes of children admitted to hospitals with acute asthma exacerbations.
|Asthma||Other: Nursing-driven clinical pathway for management of inpatient asthma|
|Study Design:||Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double Blind (Investigator, Outcomes Assessor)
Primary Purpose: Treatment
|Official Title:||The Impact of Implementing a Nursing-driven Clinical Pathway for Inpatient Management of Children Admitted to a Tertiary Care Centre With a Diagnosis of Asthma: A Randomized Controlled Trial|
- Length of hospital admission, in hours [ Time Frame: Duration of hospital admission, average 2-3 days ]The participants will be followed for the duration of their hostpital admission, an expected average of 2-3 days.
- The number of inhaled or nebulized β2-agonist treatments given [ Time Frame: Duration of hospital admission, average 2 -3 days ]The participants will be followed for the duration of their hostpital admission, an expected average of 2-3 days.
- number of children transferred to the ICU [ Time Frame: During admission to hospital, average 2-3 days ]The participants will be followed for the duration of their hostpital admission, an expected average of 2-3 days.
- number of families attending asthma teaching sessions [ Time Frame: Duration of hospital admission, average 2-3 days ]
- number of children seeking medical attention for asthma-related issues [ Time Frame: Within 2 weeks of hospital discharge date ]Follow up will occur to assess all children who seeked medical attention for concerns related to asthma for two weeks post-discharge from hospital
- Nursing and physician satisfaction with the pathway [ Time Frame: At study completion, expected within 2 to 3 years ]
- patient satisfaction with the care received in hospital [ Time Frame: Within 2 weeks of hospital discharge date ]Follow up satisfaction questionaire will be completed within two weeks of discharge from hospital
- Cost analysis [ Time Frame: At study completion, expected within 2-3 years ]
|Study Start Date:||March 2012|
|Study Completion Date:||October 2015|
|Primary Completion Date:||October 2015 (Final data collection date for primary outcome measure)|
Experimental: Nursing-driven Asthma protocol
Children randomized to the intervention group will have their β2-agonist medication weaned by the nurse, according to the steps outlined in the clinical pathway. The nurse will ensure that the patient's family is booked for asthma teaching, and will also remind the physicians to fill out an asthma action plan on discharge. Detailed information as to when to contact physicians in the event of an acute deterioration of the patient is included in the clinical pathway.
|Other: Nursing-driven clinical pathway for management of inpatient asthma|
No Intervention: Physician-driven asthma management
Patients in the control group will continue receiving the current standard of care, which consists of physicians weaning the β2-agonist medication when called to the bedside by the nurse or when deemed necessary by a physician
Please refer to this study by its ClinicalTrials.gov identifier: NCT02037841
|Children's Hospital of Eastern Ontario|
|Ottawa, Ontario, Canada, K1H 8L1|