The Science Journal of the American Association for Respiratory Care

2011 OPEN FORUM Abstracts


Michael A. Spandorfer, Jacoba Piening, James L. Darby; Bon Secours St Francis Hospital, Charleston, SC

Background Aerosolized medications delivered to hospitalized patients are discreet treatments which must be initiated by clinician intervention. Most of the medications delivered by aerosol have distinct durations of action and therefore must be delivered on a specific schedule for optimal effect. Deviation from this schedule could potentially adversely affect drug effectiveness, patient care, safety and outcome. This study's objective was to measure the number of time violations of the delivery of aerosol medication to hospitalized patients as compared to the expected schedule. Method Delivery time of all regularly scheduled aerosolized (MDI/DPI/nebulized) medications given to adult patients was extracted from our hospital's bar-labeled medication delivery software from April 2011 to June 2011 and compared to the scheduled time. Time violations were considered when treatments were given greater than one hour prior or after scheduled times. We extracted medication type, aerosol type (ie. MDI/DPI vs nebulizer), patient location and time of recorded delivery then counted 1 hour pre and post violations. To compare proportions we used a two tailed two sample z test for proportions with significant set at p < 0.05. Results 10.0% of all aerosol treatments were time violations with 3.4% given early and 6.6% given late (p < 0.001). MDI/DPIs have more time violations than nebulizers (13.3% vs 8.3%; p < 0.001) with 35% early time violations (p < 0.001 compared to late) which is similar to nebulized (32.6% early; p < 0.001 compared to late). Conclusions Aerosolized medications are important interventions to maintain or improve pulmonary dynamics, provide patient care and deliver non-pulmonary active medications. Time violations of regularly scheduled aerosolized medications can be considered medication errors. Violations of the scheduling of these medications could reduce efficacy and lead to clinical deterioration if given late or cause an adverse side effect if delivered early and stacked on previous treatments. Further studies are warranted to determine if our findings can be replicated and whether these time violations have a clinical or financial effect upon care of hospitalized patients.
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