The Science Journal of the American Association for Respiratory Care

2002 OPEN FORUM Abstracts

MISSED RESPIRATORY THERAPY MEDICATION TREATMENTS: FREQUENCY AND UNDERLYING CAUSES.

Lucy Kester, RRT, MBA, FAARC, Douglas K. Orens, RRT, MBA, James K. Stoller, MD, MS, FAARC, The Cleveland Clinic Foundation, Cleveland, Ohio.

Introduction: In the context of increasing attention to medical errors, missed therapies have become an object of focus both for optimizing clinical care. Because the issue of missed treatments in respiratory therapy has received little attention to date, we undertook this descriptive study of the frequency and causes of missed respiratory therapy medication treatments at the Cleveland Clinic Hospital.

Methods: Between August 2000 and August 2001, the number of respiratory therapy medication treatments ordered, both small volume nebulizers (SVNs) and metered dose inhalers (MDIs), and the number of treatments delivered were recorded using our respiratory therapy management information system (CliniVision, Nellcor/Puritan Bennett, Carlsbad, California). Through the CliniVision system, we also documented the therapist-recorded reason(s) for each missed treatment.

Results: Over the 12-month study interval, 74,921 SVN treatments and 38,633 MDIs were ordered, for a total of 113,554 bronchodilator medication treatments. Overall, 4,012 medication treatments were missed (3.5% of total), with variation by month ranging from 2.0% to 5.0%. Table 1 presents the reported reasons that aerosolized medication treatments were missed, according to 8 coded reasons.

Table 1. Reported Reasons That Treatments Were Not Given, and % of Total

Overall
Reasons Treatments Were Missed (see legend below table)
1 2 3 4 5 6 7 8
Total 4012 1268 988 167 822 90 462 160 55
Percent (3.5%) (31.6%) (24.6%) (4.2%) (20.5%) (2.2%) (11.5%) (4.0%) (1.4%)


Legend:
1. Patient not in room, 2. Patient refused treatment, 3. Patient discharged, 4. Patient unavailable, 5. Therapist advised not to give, 6. Breath sounds clear, 7. Unable to tolerate, 8. Therapist called away emergently

The commonest reason for missed bronchodilator treatments was the patient’s being out of the room at the time of the RT’s visit (31.6%). Next most common was the patient’s refusing treatment (24.6%), followed by the patient’s being unavailable because of other activities or therapy (20.5%). The least common reason was the respiratory therapist?s being called away for other urgent care (1.4%).

Conclusions: Overall, the frequency of missing bronchodilator treatments was relatively low in this series. Based on this initial understanding, next steps include the need to develop strategies to further lower this frequency so as to optimize the allocation of respiratory therapy services, and the need to better understand the clinical consequences of missing respiratory therapies.

OF-02-014

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