PURPOSE: As a result of cystic fibrosis (CF) patients living longer, inpatient care takes place in adult hospital settings where staff is not familiar with the disease creating suboptimal health care delivery for patients. Our purpose was to study and improve inpatient CF care.
METHODS: Using Microsystems methodology a team was assembled to evaluate the care provided to CF patients. This team included two CF physicians, a CF social worker, pharmacist, nurse, CF nutritionist, respiratory therapist, unit clerk, and the father of an adult CF patient. The team met weekly to plan and implement ideas using plan-do-study-act (PDSA) cycles.
RESULTS: In surveying CF inpatients we found that the main issues were delays in administration of medications, pancreatic enzymes not dispensed with meals, and improper chest physical therapy delivery, PDSA cycles were developed to address each of these issues. They resulted in the following changes: all CF patients are admitted to one unit, a specialized CF order set was developed to ensure accurate administration of all CF medications, admission orders are written in a timely fashion, respiratory therapy (RT) delivers treatments within two hours of a patient’s arrival, the unit receptionist ensures that orders are faxed to pharmacy promptly, the pharmacy is alerted to deliver medications as soon as fax is received, and nursing assures that there is no delay in administering medications. As a result of these interventions, the time from admission to the first respiratory treatment was reduced from 13.4 hours to 2.6 hours, which remained consistent over 7 measurements.
CONCLUSION: Repeat surveys showed greater CF patient satisfaction after implementation of the interventions.
CLINICAL IMPLICATIONS: Adult cystic fibrosis inpatient care is a clinical microsystem that is amenable to improvement. The approach we used is an organized one that can be implemented in other chronic diseases.
DISCLOSURE: Mangala Narasimhan, No Financial Disclosure Information; No Product/Research Disclosure Information