The experience of the nurse at triage influences the timing of CPAP intervention.
Increasing attention in the last decade has shown that intervention of continuous positive airway pressure therapy (CPAP) in cardiogenic pulmonary oedema (CPO) markedly improves the outcome of patients presenting with acute respiratory failure. This study used a non-experimental correlational design to research the relationship between the experience of the nurse, with the application of CPAP to patients presenting to a metropolitan emergency department with CPO and to establish what difference, if any, CPAP made to outcomes. A retrospective audit of records was used to extract data on all 54 patients that received CPAP over a 12-month period. The primary outcome measures were off CPAP within 2 h, transfer to intensive care unit (ICU) or cardiac care unit (CCU) and secondary outcome measures were length of hospital stay and death. There was a trend towards more experienced nurses attending patients who required immediate treatment or treatment within 10 min. These patients were more likely to be recognised at triage as requiring CPAP therapy. The early application of CPAP reduced hospital mortality, length of stay, and the need for intubation and ventilation. Attention needs to be given on how best to educate nurses so that more patients presenting with acute respiratory failure can benefit from nurses' decision-making regarding the commencement of CPAP.
MacGeorge
Jane M
JM
Capital and Coast District Health Board and Lecturer, Graduate School of Nursing and Midwifery, Victoria University of Wellington, PO Box 600, Wellington, New Zealand. jane.macgeorge@vuw.ac.nz
Nelson
Katherine M
KM
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence / Q000592:standards*; D045422:Continuous Positive Airway Pressure / Q000379:methods / Q000451:nursing*; D016529:Emergency Nursing / Q000193:education* / Q000379:methods; D004636:Emergency Service, Hospital / Q000592:standards*; D004638:Emergency Treatment / Q000379:methods / Q000451:nursing*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009730:Nursing Assessment / Q000592:standards*; D009731:Nursing Audit; D015403:Nursing Evaluation Research; D017063:Outcome Assessment, Health Care; D018579:Patient Selection; D012131:Respiratory Insufficiency / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D013997:Time Factors; D014218:Triage / Q000592:standards*