B45-07 Singing the Song of Acapella - A Qi Project

Introduction Bronchiectasis is characterized by permanent dilation of the bronchi with clinical symptoms of sputum production, cough, and increased susceptibility to recurrent pulmonary infections (1). Airway clearance allows for improvement of symptoms and reduction in exacerbation frequency with hopes of preventing cyclic bacterial colonization and subsequent inflammation (2). This quality improvement project aimed to improve adherence with the acapella valve in hospitalized patients with bronchiectasis to promote sputum clearance, prevent atelectasis, and reduce risk of infection. Methods We included 64 patients over 18 months with radiographic findings of bronchiectasis such as large bronchial diameter, airways within 1 cm of pleura, and lack of airway tapering; we did not require typical consensus definitions for inclusion. Upon receiving the acapella valve, patients were given a pre-survey to assess understanding of the valve and to demonstrate use. Targeted education was subsequently provided by the clinician team in addition to a visual handout (Figure A) that explained the valve’s purpose and technique. A demonstration was conducted to ensure patient understanding. Prior to discharge, a post-survey based on a Likert scale assessed for understanding, technique, and confidence in use. Results A total of 64 patients with bronchiectasis were included in our acapella valve education and completed the pre-survey and post-survey. Mean scores, as measured on a Likert scale, improved for all questions posed in the survey with statistical significance. A paired t-test was utilized to assess the data. Understanding of valve purpose improved from 2.48 to 4.19 (p < 0.001). Understanding of proper valve technique/use improved from 2.36 to 4.17 (p < 0.001). Confidence in valve use in the home setting improved from 2.42 to 4.34 (p < 0.001). Discussion Through targeted education and demonstration by the clinician team, patients’ understanding and confidence in acapella valve use for airway maintenance in bronchiectasis were improved. Our intervention reinforces how education is the responsibility of all participating care teams and how critical understanding diagnoses is to justify interventions for patients. Future studies could be done to investigate whether this intervention affected readmission rates or post-care complications. This data suggests that the education intervention had a significant effect on understanding valve purpose, technique, and patients’ confidence for use at home. Conclusion Management of bronchiectasis includes both pharmacological intervention and airway clearance to prevent exacerbations. This study displays the effectiveness of provider-led education in the inpatient setting to improve patient understanding of an airway clearance device.