Implementation of an Evidence-Based Incentive Spirometry Guideline: An Initiative to Promote Pediatric Sickle Cell Nurses’ Knowledge and Documentation Adherence

Abstract

Over 50% of children with homozygous sickle cell disease (HbSS) will have at least one episode of acute chest syndrome in the first decade of life. Literature validates that incentive spirometry use in patients with sickle cell disease suffering from vasoocculsive crisis reduces the incidence of acute chest syndrome. The project site, an outpatient pediatric clinic, had no guidelines for the nursing staff regarding the initiation of incentive spirometry for sickle cell patients. The primary aim was to assess nursing knowledge and documentation adherence pre- and post-educational session about a new evidence-based incentive spirometry guideline. Secondary aims were to: (1) discover common themes about the implementation of the new guideline and (2) determine similarities or differences of adherence to documentation related to demographic characteristics of the nurses. First, a guideline was created to guide the proper use of incentive spirometry in sickle cell patients requiring urgent care. Education was then provided to the nurses surrounding this new guideline. Two informal focus groups (at 2 weeks and 9 weeks) were held to incorporate nursing feedback regarding guideline implementation. Documentation data were extracted from the charts to determine adherence to the new guideline. Nurses’ knowledge (N = 13) about incentive spirometry usage improved significantly from pre-test (Mean = 2.92) to post-test (Mean = 4.62) (p = .002). The rate of documented adherence demonstrated the staff’s willingness to incorporate the new guidelines as 14 out of 31 encounters included documentation. There is room for improvement. The qualitative data obtained during the focus groups supported the use of “nurse champions” and the use of verbal and printed reminders to encourage adherence. The use of “nurse champions” is important to sustain this practice change.