Telerheumatology: Moving Toward Usual Care

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Iris Thiele Isip-Tan

Presentation at the 2023 Philippine Rheumatology Association annual convention. 2 Feb 2023, Baguio City.

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Phang, K. F., Santosa, A., Low, B. P. L., Tan, P. S. H., Khong, Z. W., Lim, A. Y. N., Teng, G. G., & Tay, S. H. (2020). A nurse-led, rheumatologist-assisted
telemedicine intervention for dose escalation of urate-lowering therapy in gout. International journal of rheumatic diseases, 23(9), 1136–1144.

Phang, K. F., Santosa, A., Low, B. P. L., Tan, P. S. H., Khong, Z. W., Lim, A. Y. N., Teng, G. G., & Tay, S. H. (2020). A nurse-led, rheumatologist-assisted
telemedicine intervention for dose escalation of urate-lowering therapy in gout. International journal of rheumatic diseases, 23(9), 1136–1144.
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Telerheumatology: Moving Toward Usual Care

Telerheumatology: Moving Toward Usual Care

Telerheumatology: Moving Toward Usual Care

Telerheumatology: Moving Toward Usual Care

Telerheumatology: Moving Toward Usual Care

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Nursing Research � January/February 2010 � Vol 59, No 1, 18–25 Effectiveness of an Aspiration Risk-Reduction Protocol Norma A. Metheny 4 Jami Davis-Jackson 4 Barbara J. Stewart b Background: Aspiration of gastric contents is a serious prob- lem in critically ill, mechanically ventilated patients receiving tube feedings. b Objectives: The purpose of this study was to evaluate the effectiveness of a three-pronged intervention to reduce aspiration risk in a group of critically ill, mechanically ventilated patients receiving tube feedings. b Methods: A two-group quasi-experimental design was used to compare outcomes of a usual care group (December 2002YSeptember 2004) with those of an Aspiration Risk- Reduction Protocol (ARRP) group (January 2007YApril 2008). The incidence of aspiration and pneumonia was compared between the usual care group (n = 329) and the ARRP group (n = 145). The ARRP had three components: maintaining head-of-bed elevation at 30- or higher, unless contraindicated; inserting feeding tubes into distal small bowel, when indicated; and using an algorithmic approach for high gastric residual volumes. b Results: Two of the three ARRP components were imple- mented successfully. Almost 90% of the ARRP group had mean head-of-bed elevations of 30- or higher as compared to 38% in the usual care group. Almost three fourths of the ARRP group had feeding tubes placed in the small bowel as compared with less than 50% in the usual care group. Only three patients met the criteria for the high gastric residual volume algorithm. Aspiration was much lower in the ARRP group than that in the usual care group (39% vs. 88%, respectively). Similarly, pneumonia was much lower in the ARRP group than that in the usual care group (19% vs. 48%, respectively). b Discussion: Findings from this study suggest that a combi- nation of a head-of-bed position elevated to at least 30- and use of a small-bowel feeding site can reduce the incidence of aspiration and aspiration-related pneumonia dramatically in critically ill, tube-fed patients. b Key Words: enteral nutrition & preventive measures & respiratory aspiration Frequent aspiration of gastric contents predisposes tube-fed patients to pneumonia, especially those who are critically ill and mechanically ventilated. Airway protection from regurgitated gastric contents often is impaired in these patients by underlying illness, sedation, or both. A number of interventions have been proposed to minimize aspiration. For example, a research-based guideline issued by the Centers for Disease Control and Prevention recommends a head-of-bed position elevated to at least 30- to reduce risk for aspiration- related pneumonia (Tablan et al., 2004). Further, a fre- quently cited study of aspiration in mechanically ventilated patients found that aspiration was significantly more likely when patients were supine; however, it also occurred when they were semirecumbent (Torres et al., 1992). .

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31. Phang, K. F., Santosa, A., Low, B. P. L., Tan, P. S. H., Khong, Z. W., Lim, A. Y. N., Teng, G. G., & Tay, S. H. (2020). A nurse-led, rheumatologist-assisted telemedicine intervention for dose escalation of urate-lowering therapy in gout. International journal of rheumatic diseases, 23(9), 1136–1144.

32. Phang, K. F., Santosa, A., Low, B. P. L., Tan, P. S. H., Khong, Z. W., Lim, A. Y. N., Teng, G. G., & Tay, S. H. (2020). A nurse-led, rheumatologist-assisted telemedicine intervention for dose escalation of urate-lowering therapy in gout. International journal of rheumatic diseases, 23(9), 1136–1144. N = 127

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