Impact of an education program in respiratory therapy quality of care

Introduction

The respiratory therapist has a central role in the management of critically ill patients. The objective of this study was to evaluate the impact of an education program aiming to improve quality of care of respiratory therapy.

Methods

A before-after study was designed to assess compliance to 15 respiratory therapy indicators, chosen due to their relevance in patient care and availability for objective measurement, in all patients admitted to the ICU regardless of mechanical ventilation or not. Compliance was assessed during 1 month before implementation of the education program. The educational process comprised of meetings, group training, written manuals and individual feedback for noncompliance situations. After 6 months of the implementation process, compliance assessment was again performed. Results were expressed as percentages and comparisons were performed through the chi-square test. Results were considered significant if P < 0.05.

Results

In both periods 80 patients were observed, with a total of 1,212 observations in the before period (BP) and 1,369 observations in the after period (AP). Compliance rates improved for almost all indicators as follows: chart registration (CR) of weight/height (BP = 97.7%; AP = 99.4%; P = 0.0026), CR of weight-predicted tidal volume (BP = 73.3%; AP = 94.7%; P = 0.000), CR of orotracheal tube fixation level (BP = 69.5%; AP = 93.6%; P = 0.000), CR of humidification line change date (BP = 83%; AP = 89.8%; P = 0.000), CR of chest X-ray pattern (BP = 86.8%; AP = 96.9%; P = 0.000); CR of clinical decisions during round (BP = 91.3%; AP = 98.7%; P = 0.000), actual compliance to clinical decisions during rounds (BP = 79.77%; AP = 98.8%; P = 0.000), correct utilization of mechanical ventilation humidification (BP = 75.9%; AP = 96.4%; P = 0.000), actual tidal volume between 6 and 8 ml/kg predicted body weight (BP = 82.0%; AP = 96.3%; P = 0.000), adequacy of ventilators alarms (BP = 69.5%; AP = 95.4%; P = 0.000), actual plato pressure <30 mmH₂O (BP = 93.2%; AP = 95.7%; P = 0.0241). Some indicators did not show a statistically significant improvement: CR of secretion aspect (BP = 94.4%; AP = 94.2%; P = 0.861), CR of circuit change date (before = 90%; after = 92.2% P = 0.0848) and CR of round changes (BP = 92.0%. AP = 92.6%; P = 0.551). Only CR of cuff pressure had a lower compliance on the AP (BP = 87.5%; AP = 79.4%; P = 0.0005).

Conclusions

An education program based on protocol-driven actions and training is able to improve compliance in respiratory therapy quality indicators. The clinical relevance of this compliance improvement still needs to be established.