Impact of an Emergency Nurse–Initiated Asthma Management Protocol on Door-to-First-Salbutamol-Nebulization-Time in a Pediatric Emergency Department

ObjectiveTo determine the effect of an ED nurse-initiated asthma management protocol on door to first salbutamol nebulization time.MethodsThis was a prospective before-after study. Asthmatics, aged 1 to 12 years presenting to the ED with an exacerbation during the pre and post nurse-initiated care phases (from 1/22/08 to 2/8/08 and from 2/12/08 to 3/4/08), were eligible. An asthma training program was administered to nurses prior to post phase. Respiratory therapists started the first nebulization after a physician order during the pre phase, whereas bedside nurses initiated it before physician evaluation during the post phase. Mean differences and confidence intervals (CI) were calculated.ResultsEach of the study groups had 125 patients. Door to first nebulization time was reduced by a mean of 31.3 minutes (CI 23.0, 39.6) in the post phase. Door to steroids, second nebulization, and bedside nurse evaluation time intervals were reduced by 22.8 minutes (CI 8.8, 36.9), 21.7minutes (CI 9.1, 34.4) and 15.6 minutes (CI 7.5, 23.7) respectively.ConclusionAn ED nurse-initiated asthma management protocol expedited initiation of medications essential for relief of symptoms of acute asthma and bedside evaluation by nurses. Standing nurse-initiated care protocols may proveto be beneficial in improving acute asthma care in crowded EDs.