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.