INCENTIVE SPIROMETERS TO PATIENTS' BEDSIDES;LESSONS LEARNED FROM A QUALITY ASSESSMENT CYCLE

Purpose/Background: Identify barriers for compliance with orders for incentive spirometer (IS) to be at postoperative patients' bedside on POD 0/1 with patient education on use. Hypothesis/Aim: There are barriers to order compliance that are not readily identifiable. Methods/Interventions: Many of our elective post-colectomy patients were not receiving incentive spirometers (IS) to the bedside on postoperative day (POD) 0/1 as ordered. This is important since our patient population is older than ever before, with comorbidities that elevate risk for pulmonary complications. We collected baseline data on the frequency of successful order completion. We focused intervention on the unit caring for the vast majority of our postoperative patients. Head nurses of both the preanesthesia unit and the postoperative unit were interviewed to clarify how orders for IS and teaching were fulfilled. A plan was enacted to improve the rate of IS being at the patient bedside on POD 0/1. Data was then collected over a four month period after the plan's implementation. This took place in a single center tertiary care center. Results/Outcome(s): Baseline data revealed an overall rate of IS to patient bedside on POD 0/1 of 31%. Process was that IS and teaching are provided to patient in pre-anesthesia setting. IS then may go to postop area with patient belongings, or family may inadvertently take the IS home. This often requires an additional IS to be provided after the lack is noted by surgical caregivers, and often includes a 24+ hour lag time. Intervention was enacted of placing IS in clear plastic bag, separate from other belongings, and family educated to allow IS to accompany patient to postoperative unit. After intervention was instituted, overall success rate of IS to patients on POD 0/1 rose to 46%, and on the unit caring for most CRS patients success rate was 62.5%. Limitations: Short time frame for data collection and education of nursing and support staff. High rate of nursing turn-over during the COVID-19 pandemic. Conclusions/Discussion: There can be many reasons that a written order is not executed as planned. When the number of individuals and units involved in the order execution increases and is elastic or variable, there are many possible points at which the expected execution can fail. Identification of the simplest pathway can aid in all the stakeholders being more motivated to help the pathway succeed.

Home program of cardiac rehabilitation in pandemic era for improving functional capacity after prolonged hospitalization: Post mitral valve replacement surgery and diabetes mellitus

Objective: Heart disease due to valvular anomaly has increased prevalence along with increasing age. The operative management including reparation or substitution with prosthetic valve is the main therapy. Cardiac rehabilitation is a multidisciplinary program established to assist individuals with heart disease in achieving optimal functional capacity. It is a complex and customized to individual patients with various cardiovascular diseases. Cardiac rehabilitation has become an accepted adjunct treatment for the majority of patients with cardiovascular disease, especially for those who have received cardiac surgery. Diabetes mellitus is a common comorbidity in patients with cardiovascular disease, particularly in elderly patients, since many risk factors are shared between the two diseases, and diabetes mellitus increases the risk for cardiovascular disease and postoperative complication, so it can affect the rehabilitation program. The outpatient program called Cardiac Rehabilitation Phase II is designed to meet the needs of the patient once the patient has left the hospital. The program consist of exercises that are supervised in cardiac rehabilitation center to monitor patient's responses to exercise. During the Covid-19 pandemic, non-emergency visit to the outpatient clinic are advised to be postponed. Home program become an important role in cardiac rehabilitation. Methods: A case of 61 years old male patient with severe mitral regurgitation and type 2 diabetes mellitus underwent mitral valve replacement surgery. The patient had wound healing problem during hospitalization. The phase 1 cardiac rehabilitation programs were prolonged due to the patient condition and the long duration of the length of stay at hospital. Due to Covid-19 pandemic, the patient underwent home program for phase II cardiac rehabilitation after he discharged from the hospital, monitoring by online communication. Result: There were increasing of count test, incentive spirometer, distance of 6 minute walking test, and METs results. Conclusion: Comprehensive home program cardiac rehabilitation with monitoring, increase the functional capacity of patient with mitral valve replacement surgery and diabetes mellitus after prolong hospitalization.

Assess The Effectiveness of Deep Breathing Exercise with Incentive Spirometer on the Respiratory status of Cardio Thoracic and Vascular Patients

Incentive spirometer (IS) is a device which inspires the patients to take a deep breath and produce a sustained maximal inspiration for the primary purpose of opening and stabilizing atelectasis areas of the lung. IS is essential to the thoracotomy patients by increasing inspiratory capacity and improves inspiratory muscle strength in patients. IS is designed to mimic natural sighing or yawning by encouraging the patient to take long, slow, deep breaths. People living with chronic lung diseases, such as chronic obstructive pulmonary disease (COPD), COVID 19, emphysema and pulmonary fibrosis, experience similar lung disease symptoms. Shortness of breath and decreased lung function make breathing difficult. Dysfunctions of the breathing pattern can be first indicators of a problem within the human body, be it of mechanical, physiological or mental kind. Incorrect breathing can be caused by blocked ribs or vertebra, dysfunction of breathing and stabilising muscles, allergies, lung diseases, heart failures and above all excessive stress.The Present study focuses on to assess the effectiveness of deep breathing exercise with incentive spirometer on the respiratory status of patients who have undergone cardio thoracic and vascular surgery during post test. There is no significant association between the effectiveness of deep breathing exercise with incentive spirometer on respiratory status of patients who have undergone cardio thoracic and vascular surgery and demographic variables.

Efficacy of Incentive Spirometer in Increasing Maximum Inspiratory Volume in an Out-Patient Setting.

Background Incentive spirometry (IS) is the mainstay of care in postoperative patients that has been heavily studied in the inpatient setting. Studies have shown that the utilization of IS improves lung volumes and reduces the rate of pneumonia in post-surgical patients. However, the literature is ambiguous on its benefit as many studies also demonstrate no significant benefit, especially in comparison to early ambulation. Our study sought to determine whether a consistent IS regimen can improve lung function in an outpatient setting. Methods This prospective cohort study included patients in a physical medicine and rehabilitation clinic setting during the COVID pandemic. Patients with severe respiratory disease, baseline cough, those unable to perform deep breathing, fever greater than 100.4 F due to non-pulmonary on initial evaluation, or inability to fill out the forms and complete the study were excluded. Each participant was given the IS along with hands-on instruction on how to use the device and accurately record measurements. Patients were asked to lie down and inhale and exhale through the tube ten times. They were asked to mark the highest volume during their 10 breaths. Patients were instructed to complete this exercise three times a day for 30 days. Patients were also asked to perform light exercises or walking for 20 minutes per day three times a week and postural drainage. Patients were instructed to call their primary care physician if a 20% or more decrease from their baseline was noted or if they experienced any new coughs, fever, or shortness of breath during the 30 days of exercise. Results A total of 48 patients enrolled in the study with a (median) age of 58.0 years (SD 10.2 years), 21 females and 27 males. Baseline maximal inspiration for study participants was 1885.4 mL prior to exercise, with a subsequent increase in lung capacity observed for all participants enrolled in the study. At the end of the study period, week four, the average maximal inspiratory volume was 2235.4 mL. Paired t-test showed a significant difference between baseline (1885.4) and maximum (2235.4) volumes (t=-4.59, p<0.0001). Analysis of variance (ANOVA) showed no significant difference among Week 1-4 averages (F=1.08, p=0.36). None of the participants reported any symptoms (fever, coughing, shortness of breath) or COVID-19 infection during the 30-days period. None of the participants reported contacting primary care physicians.  Conclusion When prescribed daily breathing exercises with an incentive spirometer, study participants experienced a 16% increase in maximal inspiratory volume over a span of 30 days and did not need to contact their primary care physician during the study period.