Asthma — Sample Patient Progression in Asthma Pathway — Clinical Pathway: Inpatient

Asthma Clinical Pathway — Inpatient

Sample Patient Progression

Assessment Severe Severe Severe Moderate Moderate Moderate Moderate Moderate Moderate
Pathway Level Severe Severe Severe Severe Severe Severe Severe Moderate Moderate
Time 2100 2200 2300 2400 0100 0200 0300 0400 0600
Albuterol Continuous Continuous Continuous Continuous Continuous * * Stop
Continuous		 No Treatment Treatment Treatment
Assessment CRM
Continuous pulse ox

Temp once		 CRM
Continuous pulse ox		 CRM
Continuous pulse ox		 CRM
Continuous pulse ox		 CRM
Continuous pulse ox		 CRM
Continuous pulse ox		 CRM
Continuous pulse ox		 HR/RR
Spot Check pulse ox if
on oxygen

Enter Asthma Moderate Order Set		 HR/RR
Spot check pulse ox
Assessment Moderate Moderate Mild Mild Mild Mild Mild
Pathway Level Moderate Moderate Moderate Moderate Moderate Mild Mild
Time 0800 1000 1200 1400 1500 1600 2000
Albuterol Treatment Treatment Treatment No Treatment No treatment * * Treatment Weight based dose * * Treatment Home dose
Assessment HR / RR Spot check pulse ox if on oxygen HR / RR Spot check pulse ox if on oxygen RT assessment HR / RR PASS score =0 RT assessment HR/ RR PASS score =0 RN assessment HR / RR PASS score =0 RT assessment HR / RR PASS score =0

Enter Asthma Mild Order Set		 RT assessment HR / RR PASS score =0

**Denotes changes in treatment regime**

Have FLOC enter a variance order to support and progression or regression in patient’s status that falls outside the pathway standard
 

Transition: Severe to Moderate

  1. After 2 hrs of moderate/severe (total of 3 moderate/severe assessments) stop continuous albuterol
  2. Continue hourly assessments and document for 2 more hrs
  3. Give treatment 2 hrs after continuous albuterol stopped and change to moderate order set

Transition: Moderate to Mild

  1. Must be on RA (no oxygen requirement)
  2. At 1st mild/moderate assessments (treat)
  3. Assess in 2 hrs then hourly x2 hrs (hold if mild)
  4. Assess and give treatment on 4th hr from last treatment
  5. After 4 more hrs, give home dose and continue until discharge
  6. Educate and demonstrate inhaler and spacer technique
  Severe Moderate Mild
Assessment
  • Significant work of breathing, accessory muscle use, and nasal flaring
  • Wheezing: no wheeze or inspiratory and/or expiratory
  • Aeration: decreased throughout
    lung fields
  • Prolonged expiration present
  • Cough: weak or absent
  • FIO2: > 40% with pulse ox ≥ 90%
  • Mild or moderate work of breathing, accessory muscle use, and nasal flaring
  • Wheezing: expiratory
  • No prolonged expiration
  • Cough: loose and productive
  • FIO2: 21% -40% with pulse ox ≥ 90%
  • No or minimal work of breathing
  • Wheezing: intermittent, minimal or none
  • No prolonged expiration
  • Cough: full, loose and productive
  • FIO2: 21% with pulse ox ≥ 90%
Monitoring
  • Assess q1hr, q2hr by RT
  • Continuous CRM
 q2hr assessments by RT q4hr assessments by RT
Medications
  • Continuous Albuterol Dosages
    • Full Dose
      • > 20 kg = 3 ml/hr
      • 10-20 kg = 2.25 ml/hr
      • 5-10 kg = 1.5 ml/hr
    • Additional Medications
      • Prednisone or methylprednisolone,
        as ordered
  • Albuterol Treatment Dosages
    • Dose
      • > 20 kg = 8 puffs q2hr
      • 10-20 kg = 6 puffs q2hr
      • 5-10 kg = 4 puffs q2hr
    • Additional Medications
      • Continue Prednisone
  • Albuterol Treatment Dosage
      • First q4hr
      • > 20 kg = 8 puffs
      • 10-20 kg = 6 puffs
      • 5-10 kg = 4 puffs
      • Second q4hr (home dose)
      • 2 puffs
      • 2 puffs
      • 2 puffs
    • Additional Medications
      • Continue home dose q4hr until discharge
      • Continue prednisone