Abstract Rationale Impaired cough can lead to increased respiratory morbidity and mortality. Cough peak flow (CPF) is an objective tool that can be used to measure cough strength. Identifying an ineffective cough can guide cough augmentation strategies, such as mechanical insufflation-exsufflation (MI-E). However, curricula on measurement of cough strength and application of MI-E have not been prioritized outside of respiratory therapy training standards. Nevertheless, the identification and management of patients with ineffective cough are important skills for all members of the interprofessional team. We aim to develop a targeted interprofessional curriculum for evaluating cough strength using CPF and clinical application of MI-E for patients with ineffective cough, beginning with the needs assessment described here. Methods Following a targeted needs assessment that identified the prevalence of patients with ineffective cough and inadequate cough augmentation strategies on an inpatient pulmonary intermediate care unit, an assessment tool was created to guide and evaluate a targeted interprofessional curriculum on cough strength and augmentation. The three domains of focus were knowledge, skills, and attitudes around cough strength assessment and MI-E. The study population includes pulmonary/sleep medicine faculty, nurse practitioners (NP), pulmonary/critical care fellows, respiratory therapists (RT), and registered nurses (RN). We identified critical domains via literature review and expert pulmonary/sleep medicine faculty consensus. A scale was then developed using a 5-point Likert and multiple-choice questions (MCQs). The revised scale subsequently underwent an iterative review amongst multi-disciplinary experts and then distributed amongst the study population to characterize the pre-curricular baseline. Results Ineffective cough was prevalent amongst pulmonary step-down unit patients sampled, 79.5%, yet only 6% patients had appropriate MI-E orders (Figure 1B). 48 participants completed the pre-curricular assessment scale (20 RT’s, 16 fellows, 7 faculty, 3 RNs, and 2 NP’s). Amongst participants, respiratory therapists had the highest percent correct total knowledge-based answers (Figure 1C). 98% of all participants believed assessing cough strength was important while 45.8% believed cough strength assessment was time consumptive. 77.1 % were confident in managing patients with ineffective cough, yet only 50% (16 of which were RT’s) had received formal MI-E training (Figure 1A). Conclusion Cough strength assessment and MI-E application are important for reducing respiratory morbidity. Our needs assessment will be used to design, implement, and evaluate an interprofessional curriculum on identification and management of ineffective cough with implementation of MI-E to enhance knowledge, skill and confidence of caring for patient with ineffective cough at risk for respiratory failure. This abstract is funded by: none
Simpson-Shelton et al. (Fri,) studied this question.