1995 OPEN FORUM Abstracts
THE EFFECT OF RCP DETERMINATION OF DEVICE, DOSE, FREQUENCY AND PATIENT SELF ADMINISTRATION OF MEDICATED AEROSOLS
J. Fink, MS, RRT, Ruth Lyles, RRT, E. Haggerty, RN, E. Belingon, RRT, P.J. Fahey, MD. Hines VA Hospital, Hines IL.
In 1993, only 70% of ordered aerosol treatments were completed on acute care floors, with > 95% administered by small volume nebulizer (SVN) in the hospital, although > 90% of the patients used metered-dose inhalers (MDI) at home, often with inadequate instruction in their use. Patient satisfaction surveys rated respiratory care below the 50th percentile. Guidelines for dosage and substitution of specific drugs for MDI, SVN and Mechanical Ventilator administration were incorporated in a multidisciplinary hospital wide policy with Nursing, Medicine, Surgery, Pharmacy and Respiratory Care Services by which RCPs determine appropriate aerosol device, titrate bronchodilators to response and adjust frequency of administration. RCP also instructs patient in self administration when dose and frequency are at standard levels. By April 1994, the policy was fully implemented, with 98% of patients receiving MDI with holding chamber, and 99% of ordered treatments accomplished, reducing workload by 5 FTE (allowing a full time RCP to be assigned to outpatient clinics). While total number of aerosol treatments remained stable, hours of direct patient contact was reduced by 45%. Savings of > $78,000/year based on reduced time per treatment with MDI and RCPs training patients to competently self administer therapy in the hospital. After the first year, the Press-Ganey report of patient satisfaction for our hospital identified Respiratory Care Services to be in the top 96th percentile of positive responses.
We conclude that when RCPs are empowered by the medical staff to determine device, dose and frequency of aerosolized medication, with an emphasis on patient education and clinical response, patient satisfaction is improved and hospital costs are reduced.