ED nurses share best practices for asthma
Never delay the start of oral steroids for children with asthma, warns Anne Borgmeyer, RN, an ED nurse at St. Louis Children's Hospital.
"Oral steroids are crucial to reducing the airway inflammation that leads to severe distress," she says. "The oral steroids can be given by mouth and do not necessitate starting an IV."
To improve the outcomes of children with asthma, do the following:
- Give medications immediately.
"Intervening immediately for an acute asthma attack is our mission," says Stephanie Haler, RN, manager of the ED at Clarian North Medical Center in Carmel, IN. "We use a rapid assessment method for pediatric asthma patients. Rapid intervention is critical to a positive outcome for a severe asthma attack."
This method allows ED nurses to classify the patient into a mild, moderate, or severe category, which helps to guide their treatment. For severe asthma attacks, ED nursing care is driven by protocol, with immediate administration of albuterol nebulizer, and assessment of peak flow before and after. Diana Volpe, RN, an ED nurse at Children's Hospital Boston, says, "We give our meds within 30 minutes of arrival of triage. We are very much on top of that, and have 100% compliance."
After the first medication, if there is an incomplete response and the patient still is wheezing, nurses give corticosteroids steroids within 120 minutes. "We are meeting that goal so well that we lowered it to 90 minutes," she says. "If you stay on top of this, and get the steroids in early, you might be able to turn a patient around and avoid an admission."
- Closely assess patients so they get treatments in a timely manner and don't have to wait for needed doses. "Stack those nebulizers every 20 minutes, and do an asthma severity score to see what the response is," says Volpe. "Make sure the reassessment happens after each and every one."
- Instruct patients to follow up with their primary care provider in three to five days.
Borgmeyer says, "This gives the provider a chance to assess for resolution of the episode and tune up the asthma action plan."
- If patients are discharged home, inform them about their medications.
"Make sure that the patient and family know when and how to give their medications," says Borgmeyer. "Ideally, patients who are going to use albuterol metered dose inhalers will have used them in the ED prior to discharge."
Sources
For more information on caring for pediatric asthma patients in the ED, contact:
- Anne Borgmeyer, RN, Emergency Department, St. Louis Children's Hospital. Phone: (314) 848-9152. E-mail: [email protected].
- Stephanie Haler, RN, Manager, Emergency Department, Clarian North Medical Center, Carmel, IN. Phone: (317) 688-3125. E-mail: [email protected].
- Diana Volpe, RN, Emergency Department, Children's Hospital Boston. Phone: (617) 355-2358. E-mail: [email protected].
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