The Science Journal of the American Association for Respiratory Care

1997 OPEN FORUM Abstracts

INTERMIT AEROSOL TREATMENT STANDARDIZATION AND ASSESSMENT PROGRAM

Susan Rinaldo-Gallo, MEd, RRT and Janice Thalman, BS, RRT. Duke University Medical Center, Durham, NC

Duke Respiratory Care Services (RCS) administers over 102,000 aerosol treatments (Txs), on Intermediate Care annually. Ordering strategies for these therapies were traditionally physician discretion. This led to a wide range of ordering frequencies and device selections. In an effort to provide more cost-effective therapy, Duke RCS established a consult service. This service was designed to have specially trained RCPs to interact with individual physicians to improve ordering practices. However, busy physician schedules, physician misunderstanding of bronchodilator pharmacology and RCS staff reductions have contributed to making this system inconsistent.

To provide a more effective service, Duke RCS in conjunction with Duke Hospital Pulmonary Division, Critical Care Committee, Credentialling Committee and with the endorsement of the Pharmacology and Therapeutics Committee and chairmen from the three major clinical departments, developed a standardized aerosol therapy delivery practice that would provide a control mechanism for more efficient resource utilization.

All bronchodilator orders would now be assessed by RCPs and classified as "Standard" or "Acute". All standardized therapy would be delivered QID or QID/QHS with Albuterol 2.5 mg by nebulizer or 2 puffs by MDI and/or Ipratropium .5 mg by nebulizer or 2 puffs MDI and/or inhaled steroids, per package insert dose. Orders assessed as acute would be consensus driven with the RCP and physician constructing a care plan. The Hospital Medical Records Committee subsequently authorized a specially trained advanced RCP to rewrite physician orders in the medical record. The physician would now be notified by sticker that the original order was changed to "standard" aerosol therapy. The physician must co-sign in 24 hours and could override it at any time.

Aerosol treatment orders were reviewed for 3 months pre and post implementation of this new system. The number of Txs ordered but not given, decreased by 4.18% representing 344 Txs that no longer required RCP time. More importantly, the number of orders requiring Txs after midnight decreased substantially (table below), resulting in a reduction of one full time RCP from night shift.

Monthly Averages No. Txs ordered % of Orders after midnight

Pre Protocol, Aug - Oct 8478 50.9

Post Protocol, Nov - Jan 8564 7.9

We conclude that this new system has resulted in more appropriate and cost effective care.

OF-97-118

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