Nurse-initiated steroids improve pediatric asthma care

Nurse-Initiated Steroids Improve Pediatric Asthma Care
Nurse-Initiated Steroids Improve Pediatric Asthma Care

HealthDay News -- Nurse initiation of oral corticosteroids before physician assessment of pediatric patients with asthma improves quality and efficiency of care provided in the pediatric ED, study data show.

Children with moderate-to-severe acute asthma exacerbations who were treated by nurses prior to physician assessment improved earlier, were discharged earlier and were less likely to be admitted, Roger Zemek, MD of the University of Ottowa in Canada, and colleagues reported in Pediatrics.

They reviewed the charts of 644 consecutive children aged 2 to 17 years to compare the outcomes of  one-to-one physician-initiated and nurse-initiated bronchodilator therapy. Oral corticosteroids were started for children with Pediatric Respiratory Assessment Measure scores ≥4. Outcomes assessed included admission rates; time to clinical improvement, steroid receipt, mild status and discharge; and the rate of return ED visit and subsequent admission.

The researchers found that children treated in the nurse-initiated phase improved a median 24 minutes earlier compared with those treated in the physician-initiated phase (P = .04) and that admission was significantly less likely if children received steroids at triage (odds ratio = 0.56).

On average, children who received nurse-initiated bronchodilator therapy received steriods 44 minutes earlier (P< .001), achieved mild status 51 minutes earlier (P=0.04) and were discharged 44 minutes earlier (P=0.02) than those who received physician-initiated therapy. No differences were observed in return visit rate or subsequent admission.

"Triage nurse initiation of oral corticosteroid before physician assessment was associated with reduced times to clinical improvement and discharge, and reduced admission rates in children presenting with moderate to severe acute asthma exacerbations," the researchers wrote.

Zemek R et al. Pediatrics. 2012; doi:10.1542/peds.2011-2347.

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