2006 OPEN FORUM Abstracts
| Table 1: Treatment Types by Unit | ||
| Nursing Unit | MDI % | HHN % |
| Medical | 72.7 | 27.3 |
| Heme-Onc | 63.3 | 36.7 |
| Surgical | 52.9 | 47.1 |
| Total | 71.7 | 28.3 |
conversion to Metered Dose Inhaler with Valved Holding Chamber (MDI-VHC) to administer inhaled bronchodilators in a pediatric hospital
John
Salyer RRT, MBA, FAARC,
Dave Crotwell RRT-NPS, Edward Carter MD. Respiratory Care Department,
Children's Hospital and Regional Medical Center, Seattle WA.
Background: Metered dose inhalers with valved holding
chambers (MDI-VHCs) have been shown to be equivalent or better than
hand-held nebulizers (HHN) for the delivery of bronchodilators in
children. At Seattle Children's Hospital
we implemented the conversion from HHN to MDI-delivered bronchodilators in all
non-intubated patients receiving intermittent treatments
with inhaled albuterol. Methods.
The Aerochamber-Max VHC (Monaghan) was selected because of valve design,
the anti-static polymer, and availability of different mask
configurations. Bronchodilator administration
policy and asthma-bronchiolitis
pathways were revised to recommend MDI-VHC use in lieu of HHN. Physician order sets were amended to indicate
MDI-VHC as the preferred method of delivering aerosolized bronchodilators in
children with asthma or bronchiolitis. Dosing equivalency for albuterol via HHN
versus MDI-VHC was established as 2.5 mg of albuterol by HHN = 4 puffs by MDI, and 5 mg
by HHN = 8 puffs by MDI. The conversion was advertised in various
hospital publications, and informational packets were available to community
MD's upon request. Both nurses and RTs were informed of the proposed conversion
via lectures, printed materials, and small group in-services. MDI-VHC training was made part of standard nursing
skills training. VHC's were added to the supply distribution system
(Omni-cell). Approximately six months after implementation we analyzed changes
in the method of delivery of inhaled albuterol using an electronic medication
administration record.
| Table 2: Supply and Labor Costs of 12 Treatments | ||
| HHN | MDI-VHC | |
| Supply Costs | $7.45 | $16.10 |
| Labor Costs | $159.00 | $102.96 |
| Total Costs | $166.45 | $119.06 |
Results:
Before the MDI conversion project, nearly 100% of albuterol treatments were
delivered by HHN. After the implementation we evaluated 3467 albuterol
treatments given between May and October 2005 on pediatric wards; 2485 (71.7%)
were administered via MDI-VHC vs. 982 (28.3%) by HHN. Table 1 lists the distribution of delivery
method by nursing unit. Using our
productivity measurement system we spent 35% less
time to administer albuterol via MDI-VHC compared to HHN, 13 minutes and 20
minutes respectively. However, the supply cost of an MDI-VHC was slightly
higher. Using respiratory labor and
supply/medication cost modeling of a single admission with 12 treatments, based
on our cost structure albuterol delivery with the MDI-VHC was less costly than
with the HHN (Table 2). The average length
of hospital stay (LOS) for patients with asthma has been
steadily decreasing since 2002 and this trend continued after the
implementation of this conversion program.
2002 LOS = 2.05 days, 2005 LOS = 1.52 days.
Discussion:
We successfully implemented the conversion from HHN to MDI-VHC for the delivery
of inhaled albuterol.
Since implementing the conversion, our respiratory
therapy operating cost per respiratory
therapy workload unit (relative value unit) has decreased by15% after
adjustment for inflation. We speculate
that our MDI conversion program made a significant contribution to this reduced
cost structure, as well as other factors. It has been
reported that families preferred MDI to HHN (Pediatr
2000;
106:311-317) and this has also been our
experience.
| Table 1: Treatment Types by Unit | ||
| Nursing Unit | MDI % | HHN % |
| Medical | 72.7 | 27.3 |
| Heme-Onc | 63.3 | 36.7 |
| Surgical | 52.9 | 47.1 |
| Total | 71.7 | 28.3 |