The Science Journal of the American Association for Respiratory Care

2011 OPEN FORUM Abstracts


Sandra M. Petter, Diane Siemens; Respiratory Therapy, Norton Healthcare, Louisville, KY

Background: A multidisciplinary team of pharmacists, RTs and Quality Directors reviewed data and protocols currently in place at other sites. They devised a plan for the implementation of a common canister process, therapeutic interchange of respiratory medications, and new order sets for COPD patients. Objective: Monitoring of patient safety with the new common canister protocols, cost savings with a per puff charge structure for MDIs, cost savings for RT medications by using therapeutic interchange process and best practice care of the COPD patients with the new order sets. Methods: With the implementation of the common canister process, we decided to exclude ventilator and isolation patients and to require a one-way valved spacer for each patient using a CC. Patients all would have their own spacer which would improve medication delivery. CC use also allows for a per puff charge vs charging patients for the entire canister, thus reducing cost for the patient and facilities. Thorough cleaning with 70% Isopropyl Alcohol of the CC boot would be done before and after each patient use to cleanse the MDI before utilizing on another patient. RT would be in charge of this CC administration and cleaning. So far, 70 out of 71 canisters have showed no growth of any contaminants when swabbed. Follow up action was taken to re-educate the therapist involved and proper cleaning and re-testing showed no growth of any kind post teaching. Swab testing is being performed on a routine, random basis and results of this monitor are being shared with Infection Control teams, RT teams, Pharmacy Matrix and COPD team. All are very encouraged with the results and agree the process is working as planned. Together the common canister use and therapeutic interchange are expected to save the system nearly $500,000 annually in drug costs. The swab sampling of canisters verifies that this can be done safely for the patient. Conclusion: While we are early in our process, we are already convinced that CC is a viable and safe method of reducing costs, and has actually had an impact on the rate of missed medications in two of our facilties since RT has more ready access to the MDIs needed. In the past, some delays in getting MDIs to the units contributed to the treatment being missed or started late.
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