PURPOSE: St. Luke's Hospital, a 475-bed community hospital, faced an Respiratory Therapist (RT) shortage due to an increase in census and acuity of care. Missed treatments were increasing to an average of about 400 to 500 per month. Strategies considered to meet our growing need included hiring an additional 6 RTs or decreasing workload.
METHODS: An updated RT driven protocol was put into place for all beta-agonist therapy except that prescibed by a pulmonologist. The protocol replaced previously used nebulized albuterol q4-6hrs and PRN with nebulized levalbuterol 1.25 mg BID, or q6hr while awake or Q6hr PRN depending on patient acuity. Levalbuterol 0.63 mg was substituted if beta-adrenergic side effects were problematic.
RESULTS: With implementation of the protocol, the number of nebulized doses decreased by 16,033 doses/year (from 95,629 in calander year 2005, when albuterol was used, to 79,596 in calader year 2006 with the use of levalbuterol) which equates to 334 fewer treatments per week. Missed treatments decreased to less then 20 per month with the new protocol. The majority of patients (>75%) were treated by protocol, with over 40% of them successfully treated with levalbuterol BID. RTs were able to participate in more complex procedures such as A-line insertions, attending physician rounds in the ICUs and starting a more aggresive weaning protocol to help decrease ICU length of stay.
CONCLUSION: The use of levalbuterol has allowed us to decrease our nebulizer workload, giving us the abilty to care for our critically ill patients and increase job satisfaction of the RTs. We also did not have to increase our staffing levels, which ultimately saved our institution about $320,000 calander year 2006.
CLINICAL IMPLICATIONS: With the time we no longer spend delivering nebulizer treatments, we are now able to provide more concentrated care for our critically ill patients. We have also had similar success with this protocol at our sister hospital which is a 100 bed community hospital.
DISCLOSURE: Chris Pekurny, None.