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Nebulizer Therapy in Spontaneous Breathing Patients PI

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Nebulizer Therapy in Spontaneous Breathing Patients PI …

Nebulizer Therapy in Spontaneous Breathing Patients PI
Leonor Ortiz, RRT
Ricardo Montoya, RRT, AE-C

Mano y Corazón Binational Conference of Multicultural Health Care Solutions, El Paso, Texas, September 27-28, 2013


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  • 1. Nebulizer Therapy inNebulizer Therapy in Spontaneous BreathingSpontaneous Breathing Patients PIPatients PI Leonor Ortiz, RRTLeonor Ortiz, RRT Ricardo Montoya, RRT, AE-CRicardo Montoya, RRT, AE-C
  • 2. Nebulizer TherapyNebulizer Therapy Breathing treatmentsBreathing treatments  Medication delivery to the lungs.Medication delivery to the lungs.  Improve breathing.Improve breathing.  Small airways bronchodilatation.Small airways bronchodilatation.  Promote airway hygiene.Promote airway hygiene.
  • 3. Nebulizer TherapyNebulizer Therapy Where does the inhaled aerosol go?Where does the inhaled aerosol go?
  • 4. Performance ImprovementPerformance Improvement Mask vs mouthpiece?Mask vs mouthpiece? Goals:Goals:  To assess utilization of proper treatmentTo assess utilization of proper treatment techniques.techniques.  To evaluate the impact of patient and RTTo evaluate the impact of patient and RT education on the use of nebulizers and therapyeducation on the use of nebulizers and therapy via mouthpiece.via mouthpiece.  To evaluate the maintenance of the nebulizer.To evaluate the maintenance of the nebulizer.
  • 5. Evidence BasedEvidence Based Literature SearchLiterature Search  National Asthma Expert Panel Report 2007 updateNational Asthma Expert Panel Report 2007 update  AARC- RT Aerosol Therapy Delivery GuideAARC- RT Aerosol Therapy Delivery Guide  AARC 2012 Nebulized Therapy CPG updateAARC 2012 Nebulized Therapy CPG update  Infection Control in Cystic Fibrosis: Cohorting,Infection Control in Cystic Fibrosis: Cohorting, Cross- Contamination and the RT.Cross- Contamination and the RT.  Guidelines for Preventing Health-Care-AssociatedGuidelines for Preventing Health-Care-Associated Pneumonia, 2003Pneumonia, 2003  AARC-Aerosol Delivery Devices in the Treatment ofAARC-Aerosol Delivery Devices in the Treatment of Asthma.Asthma.
  • 6. Evidence Based GuidelinesEvidence Based Guidelines  All coherent patientsAll coherent patients >> 3 yrs -use mouthpiece.3 yrs -use mouthpiece.  Educate patient on optimal breathingEducate patient on optimal breathing technique.technique.  Rinse the nebulizer with sterile water afterRinse the nebulizer with sterile water after the treatment.the treatment.  Air dry the nebulizer after the rinse.Air dry the nebulizer after the rinse.
  • 7. Current PracticeCurrent Practice Based EvaluationBased Evaluation Done in 2 ways:Done in 2 ways: Patient surveys and observationPatient surveys and observation Survey questions:Survey questions:  Were you educated on how to breathe during theWere you educated on how to breathe during the treatment?treatment?  Were you encouraged to hold your breath duringWere you encouraged to hold your breath during your treatment?your treatment?  Was your treatment given via mask or mouthpiece?Was your treatment given via mask or mouthpiece?
  • 8. Current PracticeCurrent Practice Based EvaluationBased Evaluation Observations:Observations:  Nebulizer setup (mask vs. mouthpiece)Nebulizer setup (mask vs. mouthpiece)  Residual solution found in nebulizerResidual solution found in nebulizer  Water bottle available for nebulizer rinseWater bottle available for nebulizer rinse
  • 9. Data Collection PeriodsData Collection Periods Current practice March- May 2012Current practice March- May 2012 New practice July- September 2012New practice July- September 2012
  • 10. RT In-serviceRT In-service All RT personnel were in-serviced.All RT personnel were in-serviced. Data collection for Mar - May reviewed.Data collection for Mar - May reviewed. Evidence based guidelines reviewedEvidence based guidelines reviewed.. Performance Improvement Expectation.Performance Improvement Expectation.
  • 11. Data Collection ResultsData Collection Results 0 50 100 150 200 250 300 350 400 Mar April May July Aug. Sept. Mouthpiece treatments Mask treatments Number of treatments
  • 12. Data Collection ResultsData Collection Results 0 5 10 15 20 25 Mar April May July Aug. Sept. Residual solution Water for rinse Number of observations
  • 13. Data Collection ResultsData Collection Results 0 2 4 6 8 10 12 Mar April May July Aug. Sept. Breathing education Breath hold Number of surveys
  • 14. Optimal Breathing Pattern EducationOptimal Breathing Pattern Education Optimal breathing technique:Optimal breathing technique: Sit patient in upright position whenever possible.Sit patient in upright position whenever possible.  Nebulizer should be upright.Nebulizer should be upright.  Breathe normally with occasional deep breathsBreathe normally with occasional deep breaths followed by a breath hold.followed by a breath hold. * Instruct on 4-5 normal breaths then a deep breath* Instruct on 4-5 normal breaths then a deep breath with a couple sec. breath hold and repeat.with a couple sec. breath hold and repeat. * Regardless of whether the treatment is given via* Regardless of whether the treatment is given via mouthpiece or mask the patient must be instructedmouthpiece or mask the patient must be instructed to breath through the mouth.to breath through the mouth.
  • 15. Nebulizer MaintenanceNebulizer Maintenance SVN Nebulizer maintenance:SVN Nebulizer maintenance: Empty any residual solution.Empty any residual solution.  Rinse with sterile water.Rinse with sterile water.  Place the nebulizer, mouthpiece, OPlace the nebulizer, mouthpiece, O22 tubing andtubing and corrugated tubing over the paper towel in the patientcorrugated tubing over the paper towel in the patient box.box.  Place all other nebulizer therapy items in the box.Place all other nebulizer therapy items in the box. * All patients receiving SVN therapy will have a (cake)* All patients receiving SVN therapy will have a (cake) box to use as nebulizer storage.box to use as nebulizer storage.
  • 16. Clinical Practice Guidelines UpdateClinical Practice Guidelines Update Nebulizer storage box:Nebulizer storage box:  The box will be provided at designated locations.The box will be provided at designated locations.  Label box with patient name, date and RT initials.Label box with patient name, date and RT initials.  Line the inside-base of box with paper towels.Line the inside-base of box with paper towels.  Change the box Q48hrs and PRN.Change the box Q48hrs and PRN.  Patient may take the box and contents home.Patient may take the box and contents home.  If the box is to be disposed of, the name must beIf the box is to be disposed of, the name must be removed.removed.
  • 17. QuestionsQuestions