1. ADVENTURES IN AIRWAY CLEARANCE: IN-CLINIC ASSESSMENT OF RESPIRATORY TECHNIQUES AND EQUIPMENT
Martina Compton, Andrea Garrod, Rhonda List, Kristi Gott, Lauren Ahrens, Deborah Froh UVA Pediatric Cystic Fibrosis Center, Charlottesville, VA, USA
Background Results-Overview Results-Equipment
Our pediatric CF clinic has previously conducted verbal review of respiratory therapy medications and equipment use. Nevertheless, our respiratory therapist (RT) noted lack of clarity in methods used at home and concerns over equipment functioning and settings.
Objective
Our aim was to directly observe and assess a comprehensive respiratory treatment session including airway clearance measures and delivery of medications using the patients’ own equipment.
HFCWO garment that is too small.
The most common issue identified was using only one continuous frequency.
Mthd = Method
Adh = Adherence
Inh = Inhaled
HTS - Hypertonic Saline
Patients could indicate multiple barriers.
14% reported no barriers.
Methods Results-Medication
RT prearranged sessions and confirmed with family shortly in advance to bring all respiratory medications, spacer, devices, nebulizers and compressor.
RT conducted a barriers questionnaire and witnessed a full treatment session, providing immediate feedback and intervention.
Assessment included: adherence to each therapy; comprehension of purpose; compressor pressure; high frequency chest wall oscillation (HFCWO) device function; and garment fit.
Reviewed proper nebulizer kit for each medication, order of therapies, and huff cough.
Nebulizer cleaning methods were verbally reviewed.
Findings were documented in an EMR flowsheet and data was kept in a secure spreadsheet.
HFCWO garment being checked for proper fit.
Most patients use their devices, but many
had poor fit or suboptimal settings.
Most patients were disinfecting properly but not always
daily, and sometimes using incorrect kits.
The most frequently missed medications were ICS and
mid-day inhaled antibiotics.
Results-Technique
N = 47
n = 46
n = 45
Pressure gauge to check compressor function.
Our goal was an occlusion pressure of
> 30 psi and working pressure > 10 psi.
Conclusions
In-person respiratory assessments frequently led to discovery of errors in technique and equipment function that could not be assessed by history alone. This model allows for immediate feedback and refinement of techniques. By continuing to identify barriers and providing personalized education, we hope to improve adherence and effectiveness of respiratory therapies.
Only 28% used huff cough regularly.
The most common error was taking
dornase alfa before HTS.
MDI technique was often suboptimal.