Introducing a Pediatric Respiratory Assessment Tool in a Pediatric ED

Abstract

<p>Poster presentation</p><p>Session C presented Thursday, September 14, 2017</p><p>Purpose: The pediatric asthma patient presenting to the Emergency Room requires prompt and reliable assessment leading to timely treatment. Our current Emergency Severity Index (ESI) triage scoring system is not specific to Pediatric Asthma Assessment. The introduction of the Pediatric Respiratory Assessment Measure (PRAM), an asthma assessment tool, improved nursing assessment, communication of severity between providers, and timely care. </p><p>Design: This evidence-based quality improvement project and prospective study involved training of staff nurses in the use of the PRAM scoring tool over a 6 month period using education and training of super users, power point learning modules and practice scenarios. Super users acting as change agents were then charged with mentoring other staff members. Training also included knowledge sharing with Respiratory Therapy and medical providers. </p><p>Setting: Suburban pediatric Emergency Department that is a satellite campus of a midwestern pediatric teaching hospital. </p><p>Participants/Subjects: Participants: Pediatric Emergency Room Nurses in a Midwestern pediatric ED. All RN's in the department participated. No IRB was required for this QI project. </p><pMethods: Prospective QI study with the intention of training ED RNs to use the Pediatric Respiratory Assessment Measure, an asthma scoring tool, during initial assessment. PDSA cycles were performed regularly over 7 months to assess staff comprehension and retention of training. Reminders to use the PRAM occured during daily shift report and at unit updates. A staff comprehension and use survey was given before education to assess baseline data, and was reperformed at 1 month and 6 months post education. Medical providers and RT's were also educated on the PRAM, their comprehension retention was not measured. <p/p><p>Results/Outcomes: Preliminary findings: Percentage of RNs assigning prams during initial assessment was 55% after 6 months. </p><p>Implications: At our facility, the PRAM nursing education is part of a bigger protocol which allows nurses to initiate asthma care at the time of initial assessment. The PRAM allows nursing, providers, and respiratory therapy to communicate and collaborate regarding patient assessment and care. We are currently working to have RN's as well as RT's and medical providers utilize the PRAM score as part of continuing patient assessment and use of standing orders. </p>