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Efficacy of a Protocol to Eliminate Use of Metered-Dose Inhalers in Favor of Nebulization Therapy for Inpatient Respiratory Care FREE TO VIEW

Jenni Yoon; Nancy Hebert; Howard Freeland
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Medstar Good Samaritan Hospital, Baltimore, MD

Chest. 2014;146(4_MeetingAbstracts):551A. doi:10.1378/chest.1973537
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SESSION TITLE: Cost and Quality Improvement Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Metered-dose inhalers (MDIs) in the inpatient setting have been associated with high costs, as the number of available actuations per device far exceeds the number required during a typical hospitalization, and questionable efficacy due to ineffective patient techniques. Our clinical observations suggested the hypothesis that changing to an all nebulization protocol for inpatients would result in more effective and consistent administration of the medication, opportunities for direct patient contact with respiratory care practitioners, and cost savings for the healthcare system.

METHODS: All patients requiring MDIs admitted to Medstar Good Samaritan Hospital, an urban community teaching hospital, during an 11 month period were enrolled in an all nebulization protocol. Each patient’s MDI, including all inhaled bronchodilators and inhaled corticosteroids, were changed to nebulization therapy, using a standardized medication order sheet with mandatory replacement with a dose-comparable equivalent medication using nebulization administration. Differences in cost, length of stay, and patient satisfaction were evaluated.

RESULTS: 553 inpatients who were previously on MDIs were converted to nebulization administration using a forced replacement protocol. We estimated that the institution saved $243,472 over the 11 month study period, when compared to the previous 11 month period using MDIs. The cost-savings was primarily due to the difference in cost between MDIs and nebulized forms of the comparable medications. In addition, cost savings were also gained by eliminating the cost of replacing lost inhalers. Length of stay was also decreased, and patients perceived that their treatments were more efficacious as well. Patient and staff satisfaction surveys are currently being collected and will be graded on a five point Likerd scale.

CONCLUSIONS: Conversion to an all nebulization protocol in the inpatient setting is more efficacious when compared to MDIs by decreasing cost, reducing length of stay, and improving patient satisfaction.

CLINICAL IMPLICATIONS: Converting to an all nebulization protocol in the hospital setting decreases the healthcare cost burden and will likely be efficacious for most hospitals around the country during these cost conscious times.

DISCLOSURE: The following authors have nothing to disclose: Jenni Yoon, Nancy Hebert, Howard Freeland

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