Date of Award
2023
Document Type
Doctor of Nursing Practice (DNP)
Degree Name
Doctor of Nursing Practice (DNP)
Department
Nursing
Committee Chair
Haley Hoy
Committee Member
Jerrod Taylor
Subject(s)
Lungs--Obstructive diseases--Diagnosis, Alpha-1 antitrypsin deficiency, Genetic screening
Abstract
Alpha-1 antitrypsin deficiency (AATD) is a vastly underdiagnosed genetic disorder that can lead to early appearance of chronic obstructive pulmonary disease (COPD). The purpose of this project was to implement a screening protocol utilizing an interdisciplinary approach to increase the rate of AATD screening and treatment among COPD patients. The project population is all nurse practitioners, respiratory therapists, clinic medical assistants, and patients undergoing pulmonary functions tests in one outpatient pulmonary clinic in North Alabama. The design for this project was a clinical practice change. The evidence-based procedure involved identifying patients with irreversible airflow obstruction indicative of COPD during pulmonary function testing (PFT) and screening for AATD immediately upon recognition of the lung disease. The Doctor of Nursing Practice (DNP) student collected data to ensure program efficacy regarding staff education as well as the rate of screening in the PFT laboratory. Specifically, data were collected regarding the number of patients who underwent PFT, the number of patients with irreversible airflow obstruction who met criteria for AATD screening, the number of patients actually screened for AATD, and the number of patients referred for treatment both pre- and post-protocol implementation. Prior to the protocol implementation, 706 PFTs were performed, 203 patients met criteria for AATD screening, and 12 patients were actually screened for AATD, yielding an AATD screening rate of 5.9%. Prior to screening protocol implementation, staff were provided with a pre-test, educational session, and post-test. The average test score prior to the educational session was 83.9% and the average test score following the educational session improved to 100%. Implementation of the AATD screening protocol revealed that with 483 PFTs performed, 123 patients met criteria for screening, and 82 patients were screened, yielding an AATD screening rate of 66.7%. Furthermore, 6 patients were discovered to have potential disease-causing alleles and were referred to genetic counseling. This project effectively demonstrated that utilization of an interdisciplinary approach for AATD screening yields greater recognition and screening rates than with provider ordering alone. This method can be implemented in other outpatient pulmonary clinics to combat the extreme underdiagnosis of AATD.
Recommended Citation
Vazquez, Kelly, "Implementation of an alpha-1 antitrypsin deficiency screening protocol in an outpatient pulmonary clinic" (2023). Doctor of Nursing Practice (DNP). 60.
https://louis.uah.edu/uah-dnp/60