The Science Journal of the American Association for Respiratory Care

2005 OPEN FORUM Abstracts

WILL USING A NEW RESPIRATORY MEDICATION REDUCE THE WORKLOAD AND COST TO THE RESPIRATORY CARE DEPARTMENT.

Stephen G. Staib, RRT and Diane Doebley, RRT Respiratory Care Services Hahnemann University Hospital

BACKGROUND: Over the years there have been respiratory drugs (inhaled steroids, long- acting bronchodilators,etc. ) introduced that are useful and are supposed to decrease the dependence on the more common respiratory medications (albuterol, ipratropium bromide, etc.).When these medications are added they are suppose to reduce the amount of therapies that the respiratory care practitioner provides and therefore help reduce our sometimes overwhelming workload.

OBJECTIVE: We have recently introduced tiopropium bromide to the hospital formulary and decided to study whether the physicians changed the way they ordered respiratory medications, if there was a decrease in workload, and if so was there any cost savings.

MATERIALS: The physicians at our institution use a computer system to enter their respiratory medication orders that we then pick up during our shifts. This allowed us to download all respiratory medication orders for the areas that we are responsible for.

METHOD: We downloaded the orders for a random number of days (n=40) for four months (February 2004-June 2004) prior to adding tiopropium bromide to our formulary and a random number of days (n=42) for four months (February 2005- June 2005) after adding tiopropium to our formulary. We then compared the number of patients treated , the medications ordered, and their frequency (Q4H, QID, etc.). We limited the medications to albuterol, ipratropium bromide, albuterol/ipratropium bromide combinations (via nebulizer or metered dose inhaler-MDI), servent/fluticasone combination (dry powdered inhaler-DPI), tiopropium bromide, and fluticasone propionate MDI (we did not include levalbuterol because it is a non formulary medication at our institution). We then averaged the number and types of therapy per patient per day. With this information we then determined cost per patient per day and any time or cost savings.

RESULTS: Before adding the new respiratory medication to our formulary we found out that there was an average of forty-two patients on respiratory medications per day and 66.2% of the orders were for the bronchodilators mentioned above. Following the addition of tiopropium bromide there was an average of forty-three patients ordered respiratory medications per day and 52.7% were for the above mentioned bronchodilators.The total number of order therapies decreased from 1427 prior to the change to 1084 after the change. The total number of actual treatments change from 2156 prior to 2056 following the change.

CONCLUSIONS:

1.) While the drop in bronchodilator orders were significant (24.1%), the overall drop in the number in treatments (4.7%) was clinically insignificant.

2.) This change showed that our department workload did not significantly change with the addition of the new medication.

3.) Since the new medication is costlier than ipratropium bromide, we did not realize any cost savings.

4.) Some things that we did notice is that the physicians had a tendency to order stat and routine therapies in an inconsistent manner. Stat therapies ranged from continuous to Q4H and routine therapies ranged from Q4H to once a day (for the same drugs) no matter what the recommended dosage time was. We frequently had Q1H ipratropium bromide orders (which has since been addressed) and combing tiopropium and ipratropium bromide which is not recommended by the companies studies.

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