The Impact of Implementing a Nursing-driven Clinical Pathway for Inpatient Management of Children With Asthma

Asthma Clinical Trial

— NAP  

Official title:

The Impact of Implementing a Nursing-driven Clinical Pathway for Inpatient Management of Children Admitted to a Tertiary Care Centre With a Diagnosis of Asthma: A Randomized Controlled Trial

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT02037841
• Other study ID #: #11/10E
• Status: Completed
• Phase: N/A
• First received: July 4, 2013
• Last updated: January 29, 2016
• Start date: March 2012
• Est. completion date: October 2015

Study information

• Verified date: January 2014
• Source: Children's Hospital of Eastern Ontario
• Contact: n/a
• Is FDA regulated: No
• Health authority: Canada: Ethics Review Committee
• Study type: Interventional

Clinical Trial Summary

Asthma is the most common chronic disease of childhood and is responsible for large portion of pediatric admissions to Canadian hospitals. There is evidence that clinical pathways allow for optimal delivery of care and may result in decreased length of stay, leading to important economic benefits. Weaning of asthma medications prescribed for asthma exacerbation is not standardized in the current model of care. Currently, weaning is performed by ward physicians; in a teaching hospital, this most often done by residents staff. Differences in practice between different physicians, delays in patient assessment and adjustment of doctor's orders, likely prolong the hospital stay for children admitted with asthma.

This study's main objective is to determine the effect of a nursing-driven clinical pathway on children's length of stay when admitted to hospital with a diagnosis of acute asthma exacerbation. The pathway will allow nurses to wean a specific type of medication(β2-agonist), as compared to the current standard of care, which dictates that a physician writes an order to wean the medication. Number of administered β2-agonist treatments will be compared between both groups, as well as asthma-related health care utilization within two weeks of hospital discharge. Nursing, physician, and patients' satisfaction with the pathway will be evaluated, and a cost minimization analysis will be performed.

This study has the potential to improve resource use efficiency, increase patient safety by avoiding administration of unnecessary medications, and ameliorate quality of care by standardizing the care of children admitted to the hospital with a diagnosis of acute asthma exacerbation. The results of the study will be disseminated across the Canadian Health Care System with the goal of improving outcomes of children admitted to hospitals with acute asthma exacerbations.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 113
• Est. completion date: October 2015
• Est. primary completion date: October 2015
• Accepts healthy volunteers: No
• Gender: Both
• Age group: 2 Years to 17 Years

Eligibility

Inclusion Criteria:

• Children admitted during the study period with a diagnosis of asthma exacerbation, reactive airway disease, or wheezing

• Children aged 2 to 17 years

Exclusion Criteria:

• Children under the age of 2 years

• Children with congenital heart disease

• Children with chronic lung diseases other than asthma, including cystic fibrosis and bronchopulmonary dysplasia

• Children with severe neurological impairment

• Children with other significant co-morbid disorders

• Children whose caregivers do not understand English or French

• Children whose caregivers cannot be reached by phone for the 14-day follow up

Study Design

Allocation: Randomized, Intervention Model: Parallel Assignment, Masking: Double Blind (Investigator, Outcomes Assessor), Primary Purpose: Treatment

Related Conditions & MeSH terms

• Asthma

Intervention

Other:
• Nursing-driven clinical pathway for management of inpatient asthma

Locations

Country	Name	City	State
Canada	Children's Hospital of Eastern Ontario	Ottawa	Ontario

Sponsors (2)

Lead Sponsor	Collaborator
Children's Hospital of Eastern Ontario	CHAMO Innovation Fund

Country where clinical trial is conducted

Canada, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Cost analysis		At study completion, expected within 2-3 years	No
Primary	Length of hospital admission, in hours	The participants will be followed for the duration of their hostpital admission, an expected average of 2-3 days.	Duration of hospital admission, average 2-3 days	No
Secondary	The number of inhaled or nebulized ß2-agonist treatments given	The participants will be followed for the duration of their hostpital admission, an expected average of 2-3 days.	Duration of hospital admission, average 2 -3 days	Yes
Secondary	number of children transferred to the ICU	The participants will be followed for the duration of their hostpital admission, an expected average of 2-3 days.	During admission to hospital, average 2-3 days	Yes
Secondary	number of families attending asthma teaching sessions	The participants will be followed for the duration of their hostpital admission, an expected average of 2-3 days.	Duration of hospital admission, average 2-3 days	Yes
Secondary	number of children seeking medical attention for asthma-related issues	Follow up will occur to assess all children who seeked medical attention for concerns related to asthma for two weeks post-discharge from hospital	Within 2 weeks of hospital discharge date	Yes
Secondary	Nursing and physician satisfaction with the pathway		At study completion, expected within 2 to 3 years	No
Secondary	patient satisfaction with the care received in hospital	Follow up satisfaction questionaire will be completed within two weeks of discharge from hospital	Within 2 weeks of hospital discharge date	No