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

ABSTRACT

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.