Wheeze is one of the most common emergency department presentations for pre-school aged children (greater than 1 year, but less than 5 years). The typical treatment regime involves an intensive 'burst' of salbutamol (Ventolin) via a spacer and mask, followed by an admission to the Children's Short Stay Unit where the aim is to gradually stretch the interval between salbutamol doses to 3-hourly before discharge home. This is guided by regular, repeated assessments by a doctor or nurse practitioner.
When there is a surge in presentations to the emergency department, it becomes problematic for the treating clinician to perform these assessments in a timely fashion as they are concurrently managing several other children in the emergency department. This leads to medication delays, in some cases patient deterioration, staff and carer frustration, and challenges to patient flow.
Nurse Led Stretching of Inhaled Salbutamol is a pathway that optimises registered nurse's scope of practice to perform detailed respiratory assessments on children presenting with a wheezing illness to determine when the next dose of salbutamol should be administered. This facilitates doctors and nurse practitioners to remain on the floor seeing acute, undifferentiated patients.
