The Science Journal of the American Association for Respiratory Care

2004 OPEN FORUM Abstracts

ADOPTION OF LEVALBUTEROL AT HILLCREST MEDICAL CENTER THE EFFECT ON NEBULIZED RESPIRATORY TREATMENTS

Garfinkel F, MD, FCCP; Hillcrest Medical Center, Tulsa, OK

BACKGROUND:The Respiratory Therapy Department was frequently required to use outside (agency) therapists to meet the demand of a very high number of treatments ordered. These outside therapists were less familiar with the organization. This situation, combined with the high workload, contributed to a high number of missed treatments (which we and JCAHO consider a drug error). Additionally, due to medical concerns regarding potential detrimental effects of the (S)-isomer of racemic albuterol, we were using a large amount of nebulized terbutaline. Because of a significant increase in the cost of terbutaline and the concern about (S)-albuterol, all of the terbutaline and most of the racemic albuterol use was replaced by levalbuterol (the single (R)-isomer of albuterol).

METHOD:Nebulized racemic albuterol and terbutaline were being ordered every 4 hours and PRN. All of the terbutaline and about 70% of the racemic albuterol were replaced by levalbuterol every 6 hours and PRN. Respiratory therapy records were reviewed for: average daily census (ADC), total nebulized treatments (TNT) given each day, number of nebulizations missed (NNM) and reasons for missed treatments (lack of therapist time, patient not available, patient refused). These data were collected retrospectively for the months April 2001 – July 2002 (pre levalbuterol period) and prospectively for August 2002 – January 2004 (levalbuterol period). Data were analyzed by two-sample t-tests and significance was set at p < 0.05.

RESULTS:*

Parameter Mean (± SD) Pre-lev period Lev period P value
ADC/month 278.5 (9.93) 274.6 (9.36) 0.2486
Ave nebs/month 9363.3 (1120.5) 8100.7 (1259.4) 0.0043
TNT/pt 33.6 (4.0) 29.5 (4.2) 0.0061
NNM/pt 2.2 (0.6) 1.5 (0.4) 0.0011
Lack of time 0.26 (0.13) 0.15 (0.08) 0.0106
Pt unavailable 1.05 (0.23) 0.70 (0.17) 0.0004
Pt refused 0.89 (0.21) 0.66 (0.14) 0.0042

During the levalbuterol period, TNT decreased along with a decrease in NNM and significantly fewer treatments were refused. For similar months of treatment year-to-year, drug costs at Hillcrest Medical Center decreased from $32,708 to $13,528. There was a decrease in RT time devoted to delivery of nebulized treatment equivalent to one FTE.

CONCLUSIONS: Conversion to levalbuterol at Hillcrest Medical Center resulted in a statistically significant decrease in the number of nebulized treatments given. This decrease reduced RT workload allowing the RTs to be available to treat more critically ill patients and leading to significantly fewer missed treatments and cost savings.

*I acknowledge Ray Claus at Sepracor Inc. for conducting the statistical analyses.

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