The Impact of Implementing a Nursing-driven Clinical Pathway for Inpatient Management of Children With Asthma

NCT02037841 | Completed DMC

• 1 other identifier: #11/10E
• Study Type: interventional
• Target: 113
• Locations: 1 country
• Sites: 1

Brief Summary

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.

Conditions

Asthma

Keywords

Asthma; Nursing; Protocol; PRAM; Length of Stay; Weaning; Clinical pathway; Asthma exacerbation

Outcome Measures

Primary Outcomes (1)

• Length of hospital admission, in hours

  The participants will be followed for the duration of their hostpital admission, an expected average of 2-3 days.

  Duration of hospital admission, average 2-3 days

Secondary Outcomes (6)

• The number of inhaled or nebulized β2-agonist treatments given

  Duration of hospital admission, average 2 -3 days

• number of children transferred to the ICU

  During admission to hospital, average 2-3 days

• number of families attending asthma teaching sessions

  Duration of hospital admission, average 2-3 days

• number of children seeking medical attention for asthma-related issues

  Within 2 weeks of hospital discharge date

• Nursing and physician satisfaction with the pathway

  At study completion, expected within 2 to 3 years

Other Outcomes (1)

• Cost analysis

  At study completion, expected within 2-3 years

Study Arms (2)

Nursing-driven Asthma protocol

EXPERIMENTAL

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

Physician-driven asthma management

NO INTERVENTION

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

Interventions

Nursing-driven clinical pathway for management of inpatient asthma OTHER

Nursing-driven Asthma protocol

Eligibility Criteria

• Age: 2 Years - 17 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17)

You may qualify if:

• Children admitted during the study period with a diagnosis of asthma exacerbation, reactive airway disease, or wheezing
• Children aged 2 to 17 years

You may not qualify if:

• Children under the age of 2 years
• Children with congenital heart disease
• Children with chronic lung diseases other than asthma, including cystic fibrosis and bronchopulmonary dysplasia
• Children with severe neurological impairment
• Children with other significant co-morbid disorders
• Children whose caregivers do not understand English or French
• Children whose caregivers cannot be reached by phone for the 14-day follow up

Sponsors & Collaborators

• Children's Hospital of Eastern Ontario: lead
• CHAMO Innovation Fund: collaborator

Study Sites (1)

Children's Hospital of Eastern Ontario

Ottawa, Ontario, K1H 8L1, Canada

Location

MeSH Terms

Conditions

Asthma

Condition Hierarchy (Ancestors)

Bronchial Diseases; Respiratory Tract Diseases; Lung Diseases, Obstructive; Lung Diseases; Respiratory Hypersensitivity; Hypersensitivity, Immediate; Hypersensitivity; Immune System Diseases

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: INVESTIGATOR, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: July 4, 2013
• First Posted: January 16, 2014
• Study Start: March 1, 2012
• Primary Completion: October 1, 2015
• Study Completion: October 1, 2015
• Last Updated: February 1, 2016

Record last verified: 2014-01

Locations

CA (1)