Pathway Transitioning

Transition: Severe to Moderate:

  • Following 2 moderate assessments on the severe pathway, on the next moderate assessment (total of 3 moderate assessments) stop continuous albuterol.
  • The RT/RN will notify the Residentand Team that the patient is initiating transition from Severe to Moderate on the first Moderate assessment
  • Continue hourly assessment and document until Moderate order set is initiated
  • Give treatment 2 hours after continuous albuterol has stopped and then change to moderate order set.
  • The RT/RN will notify Resident and Team that the patient has completed transition from Severe to Moderate and the Resident will initiate the Moderate Asthma Power Plan

Transition: Moderate to mild

  • Must be on room air (RA) (no supplemental oxygen requirement)
  • Once the patient received two mild assessment with a treatment, the RT then does the second Q2 hours assessment and holds the treatment if appropriate.
  • The RT will notify the Resident and RN that the patient is initiating transition from moderate to mild on the first mild assessment and when the albuterol treatment is held.
  • The RT then assesses the patient at the next hour (third hour after the last albuterol treatment)
  • If continues to score mild, the RT does the fourth hour assessment with an albuterol treatment at the hospital acute dosing
  • The RT will notify Resident and RN that the patient has completed transition from moderate to mild and the Resident will initiate the Mild Asthma Power Plan
  • Assessments on transition should be made in 2 hours, then hourly for 2 hours (i.e. at 2 hours, 3 hours and 4 hours after transition starts) by the RT
  • Albuterol treatment is given on 4th hour from last treatment and patient is then transitioned to mild pathway.
  • The Resident will need to initiate the Mild Asthma Power Plan upon successful completion of the transition.
  • After 4 more hours, give home dose and continue until discharge.

Note: If a patient will progress outside of these guidelines, please have provider enter a variance order with note to support/explain the reason for change. All variance orders should be discussed with senior resident. The attending should be notified if there is a clinical change in the patient’s status or if there is a question or concern about the patient.