2001 OPEN FORUM Abstracts
EARLY IMPACT OF IMPLEMENTINGAN MDI PROTOCOL FOR PEDIATRIC PATIENTS
Jan Phillips-Clar BS RRT, SuzanHerzig RRT, Richard Ford BS RRT, HerbFrench RRT, Tim Morris MD. University of California San DiegoMedical Center, San Diego, California
Overview: UCSD has incorporatedseveral patient driven protocols to improve the utilization and efficiency ofrespiratory care delivery in the adult populations. The implementation of PDPsin 1993 resulted in a 40-50% reduction in bronchial hygiene interventions. Inaddition, we observed an increase in the use of Metered Dose Inhalers (MDIs)from less than 10%, to greater than 65% of total aerosol delivery. The MDI protocolprogram was expanded in June of 2000 to incorporate the pediatric population,ages 5-12, with the objective to ensure care was appropriate, that clinicalobjectives were achieved and that any potential to reduce expenses was realized.To assess the degree of early success we evaluated changes in the % of totalaerosols delivered by MDI.
Methods: The respiratory caredepartment developed an MDI protocol to meet the unique needs and considerationsof patients in the 5-12 age group. Once consensus was reached by members ofthe Pediatric Division Medical Staff, staff and faculty were trained on theuse of the protocol, and the protocol was implemented. Data was extracted fromthe department information system to determine the number of patients receivingaerosolized medication and the method of administration before and after implementationof the protocol.
Results: Data was collectedon 6,557 treatments given over a one year period prior to protocol implementationand compared to 1,568 treatments given over a three month period after protocolimplementation. The use of MDIs increased from 12% to 20% of total bronchodilatordelivery.
Discussion: Our experiencedemonstrates that an MDI protocol for Pediatric patients can be successfullyimplemented and that patients can be successfully transitioned from nebulizersto MDIs. In only three months the overall utilization of MDIs in the pediatricpopulation increased by 67%. Difficulties encountered in transitioning to MDIsin the pediatric population included the lack of information from drug manufacturersfor use in patients under 12 and the difficulty in getting small children toperform breath maneuvers that optimize deposition when using an MDI. In themonths ahead we will continue to monitor the transition to MDI and the impacton department cost and patent outcomes.