Medical-Surgical Nursing Education for Implementation of Nasal High Flow Therapy Outside the Intensive Care Setting

Abstract

Background:

Nasal high flow (NHF) therapy is an option for respiratory support in patients with acute hypoxic respiratory failure. To reduce ICU-associated costs and ease ICU bed availability, a multi-phased, comprehensive implementation strategy was designed to make NHF available outside the intensive care unit (ICU) under the supervision of pulmonology or trauma providers in cooperation with a dedicated respiratory therapy (RT) team. This included initial rescue therapy in the Emergency Department (ED) or on medical-surgical floors. All ED and floor nurses received face-to-face education and interaction with the RT team in order to deliver concise, consistent education to nursing staff and alleviate concerns in caring for NHF patients. The purpose of this study was to evaluate the nurse education process for initiating NHF therapy outside of the ICU.

Methods:

Paper surveys were given to all nursing staff prior to education and included questions about familiarity and comfort regarding NHF and perceived impact on patient care. Six months later, nurses had the option to participate in a post-implementation electronic survey. All surveys were anonymous and approved by the Institutional Review Board (IRB) at the study hospital. Descriptive statistics were reported for continuous data as means and standard deviations (SD); categorical data were reported as counts and percentages.

Results:

Overall, 167 nurses were trained over a 15-month period and 250 patients received NHF in the ED or on medical-surgical floors. Nurse respondents (N = 145) averaged 7 years of nursing experience (SD = 9) and 38% had previously cared for a NHF patient. However, prior to education 38% of nurses were unsure if NHF would positively or negatively impact patient care. On post-implementation surveys (N = 40), 93% of nurses reported that NHF was beneficial to patients and 90% reported that NHF did not interfere with patient care.

Conclusions:

Introduction of a new therapy on general hospital floors is a challenge for any hospital, therefore it is critical to establish a strategy for education and implementation prior to initiation. Study findings revealed discomfort and uncertainty among nursing staff prior to caring for NHF patients. Our comprehensive and collaborative implementation plan improved comfort among nursing staff and allowed for appropriate and optimal care for hundreds of NHF patients outside the ICU setting.

Table 1. Pre-implementation survey data (N=145).

 	All Respondents
Age, mean (SD)	34 (11)
Years as nurse, mean (SD)	7 (9)
Years as nurse at study hospital, mean (SD)	5 (7)
Nurse for <1 year, n (%)	26 (18%)
Bachelor	76 (52%)
Familiar with humidified nasal high-flow (NHF) therapy, n (%)	59 (41%)
Previously cared for a patient placed on NHF, n (%)	55 (38%)
Comfort caring for a patient receiving NHF, n (%)	&nbsp;
Very comfortable	21 (14%)
Somewhat comfortable	49 (34%)
Unsure	48 (33%)
Somewhat uncomfortable	17 (12%)
Very uncomfortable	10 (7%)
Impact of NHF on patient care, n (%)	&nbsp;
Will dramatically improve patient care	36 (25%)
Will somewhat improve patient care	53 (36%)
Unsure	55 (38%)
Will make patient care somewhat more difficult	1 (1%)
Will make patient care much more difficult	0 (0%)
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