The Respiratory
Asthma Protocol
Process
By Jennifer McComis
Introduction
 Asthma is a national epidemic
 This holds true locally as KDMC FCC
visits, admissions and ED visits have
more than doubled in the last few years
 In response our Quality Goal this year is
to implement an Asthma Protocol as well
as standing orders that follow NAEPP
(National Asthma Education and
Prevention Program) guidelines
Introduction
 This will address all of the key
components of Asthma Management
 Assessment and Monitoring
 Control of Factors Contributing to Asthma
Severity
 Patient Education
 Stepwise Approach to Pharmacologic
Therapy
 The protocol addresses Assessment,
Monitoring, Patient Education and
Stepwise Pharmacologic Therapy
Introduction
 Stepwise Approach to medication
management means that we give whatever
it takes to get the exacerbation under
control and then reduce medication – NOT
start out slowly and add medications
 Patient Education is addressed outpatient
but ordered through the protocol and/or
standing orders
 Education includes all four factors on an outpatient
basis and will decrease repeat ED visits and
hospitalizations
Introduction
 The protocol and orders sets have been
approved by the Medical Exec Committee
and Department of Pediatrics, Pulmonary
and ED
 They will be available beginning 8/1/06.
 This protocol is only for Asthma patients – All
other patients should be ordered the
“Respiratory Protocol”
 If Respiratory Asthma Protocol is ordered on a
non-asthmatic, the Respiratory Protocol will be
initiated
ED Patients
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ED physician orders “Respiratory Asthma
Protocol”
Most available therapist initiates protocol (ED
tech, Assessor or Team Leader)
If ED tech initiates protocol, the patient can
be given to the assessor or team leader when
they arrive if needed
Document assessments in Unity
Print assessments and place those on the
patient chart
If you choose to use the paper version and
enter in the computer later, make sure it is
done in a timely fashion
Respiratory Asthma
Assessment Form A
 This form uses the same
format as our
Respiratory Protocol
form.
 Determine the values for
each item and then
determine the treatment
 This form is used for
both ED patients and for
inpatients (sections are
separated by the gray
lines at the bottom)
Respiratory Asthma
Assessment Form A
 ED patients are given aerosol therapy/pulse ox
according to the first 2 rows
Respiratory Asthma
Assessment Form A
 All patients receive
 O2
 PEF monitoring
 DB&C
 Scheduled outpatient referral to AEC
Respiratory Asthma
Assessment Form A
 Inpatient aerosol therapy/pulse ox is
given according to the rows labeled
Inpatient Admission
Respiratory Asthma
Assessment Form B
 Form B is also very similar to
the Respiratory Protocol form.
 You must fill out form B also
(unless done in Unity)
 Therapy ordered must be
filled out on this sheet
 There must be clinical
indications for the therapy
we give
 There must be Outcome
Criteria (goals) that
determine whether the
patient is improving
ED Reassessment
 ED reassessment frequency is based on
severity and indicated on the protocol
 If your ED patient has resolved and
Q30 min evaluation/treatments are
unnecessary it is reasonable to treat
according to Inpatient guidelines
 Patients waiting for a room to be
admitted
 Patients waiting for other reasons and
asthma flare is resolved
If Not Admitted:
 Write “Referral to Asthma
Education so that the unit secretary
can take care of ordering and
scheduling.
 Please be sure this is completed
before patient is discharged.
If Admitted:
 Write “Referral to Asthma
Education so that the unit
secretary can take care of
ordering and scheduling
 Standing admission orders will
state “Aerosols, pulse ox and
peak flows per Respiratory
Asthma Protocol”
If Admitted:
 Based on your assessment of the patient
and the situation:
 Do the assessment for final inpatient
orders and chart those on the admission
orders in ED
OR
 Assess the patient once on the floor to
allow current therapy to improve
condition
 Either way make SURE that the patient
does not slip through and end up without
orders
Inpatient Reassessment
 Inpatient reassessment is to take
place at least once every 24
hours
 Indicate RAP and date just as
you would the RP in your
charting
Direct Admit/Inpatient
Physician Orders
 Assessor and/or Team Leader will
initiate new protocols on the floor
 The Asthma Protocol will be done
in Unity just like the Respiratory
Protocol
 Write your orders, etc, as you do
with the Respiratory Protocols
Standing Orders
 Review the available order sets
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ED Adult Admission Orders
ED Pediatric Admission Orders
Direct Admit Adult Admission Orders
Direct Admit Pediatric Admission Orders
 The common element we are concerned
with is the Respiratory Asthma Protocol
and Asthma Education
ED Admission Orders
Direct Admit Orders
The BAN Nebulizer and
the Asthma Protocol
 A breath actuated nebulizer (BAN) is a small volume
nebulizer (SVN) that aerosolizes only on inspiration.
 This results in
 Increased amount of medication being delivered to
the patient (up to 4 times as much as a standard
SVN)
 Very little dilution needed because it only nebulizes
on inspiration resulting in decreased loss of aerosol
to the environment
 Shorter but more effective aerosol therapy
 Due to the efficiency and increased effectiveness of
the BAN, it will be used with all asthma patients
able to use it
 BAN nebulizers will be changed out once per week
Conclusion
 These new processes will improve the
quality of care for our asthma patients
 We are able to treat them when and how
they need to be
 Protocol forms are available on Easy ID
 Orders are available on KDMC Intranet
 PLEASE make sure all patients have an
Asthma Education appointment before
discharge