Abstract
Background:
Dixie Regional Medical Center is a 245-bed hospital and one of 23 acute care hospitals of the Intermountain Healthcare Corporation. To improve COPD care, we implemented a Pulmonary Disease Navigator (PDN). PDN duties include the assessment of care plans, medications and their delivery. The PDN reported trends in patient inability to generate manufacturer's recommended IFR for devices ordered. Studies have suggested that IFR will determine laminar flow and better deposition of medications1, 2. Utilizing the InCheck Dial assists with patient assessment of ability to generate adequate IFR. DPIs are rated based on resistance (low to high).
Methods:
Between May 2017-March 2018, 127 patients were identified with COPD and followed by the PDN.
Results:
Of the 127 patients, 23 (18%) could not meet IFR device requirements. Detailed IFR outcomes are reported in Table 1.
Conclusions:
It is our impression that tailoring medications and delivery devices to a patient's ability is key to disease management. Our Adult RT Evaluate and Treat process includes Asthma and COPD Exacerbation Protocols. These require IFR assessment prior to transition from nebulizer to DPI/MDI. Physicians are contacted if a patient's IFR is inadequate for the device ordered. Since PDN implementation, we report these benefits: 1) physicians requesting clinic PDNs, 2) physicians requesting RRTs as telemedicine consultants, 2) enhanced patient/healthcare team communication, 3) improved timeliness of medically necessary referrals (eg, tobacco cessation, PFT, advance care planning), and 4) elevation of Respiratory Therapy as a profession. It is our impression that patients, families and members of the healthcare team benefit from detailed, timely, coordinated interventions that are best guided by respiratory therapists under the general supervision, direction and orders from physicians.
1. Kanabuchi K, Kondo T, Tanigaki T, Tajiri S, Hayama N, Takahari Y, Iwao K. Minimal inspiratory flow from dry powder inhalers according to a biphasic model of pressure vs. flow relationship. Tokai J Exp Clin Med 2011;36(1):1-4. 2. Mahler DA. Peak inspiratory flow as a criterion for dry powder inhaler use in chronic obstructive pulmonary disease. Ann Am Thorac Soc;14(7):1103-1107. doi: 10.1513/AnnalsATS. 201702-156PS.
*LPM defined as liters/minute (DPIs generally require between 30-90 LPM for adequate flow/medication delivery) View all access options for this article.Table One: Patients Unable to Meet Inhaled Medication Ordered Device IFR Requirement
Total Patients Unable to Meet Ordered Device IFR Requirementn=127 Total Patients# (%)
< 80 LPM*# (%)
< 70 LPM*# (%)
< 65 LPM*# (%)
< 50 LPM*# (%)
23 (18)
12 (9)
13 (10)
2 (2)
23 (18%) of patients had IFR < 90 LPM
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