Nebs No More After 24: Improving Use of Appropriate Respiratory Services

1University of California, San Francisco, San Francisco, CA
2University of California, San Francisco, San Francisco, CA
3University of California, San Francisco, San Francisco, CA
4University of California, San Francisco, San Francisco, CA
5University of California, San Francisco, San Francisco, CA
6University of California, San Francisco, San Francisco, CA
7University of California, San Francisco, San Francisco, CA
8University of California, San Francisco, San Francisco, CA

Meeting: Hospital Medicine 2013, May 16-19, National Harbor, Md.

Abstract number: 178

Background:

Nebulized bronchodilator therapies (“nebs”) are commonly used in the inpatient setting for the treatment of obstructive pulmonary symptoms. Neb administration, however, requires direct respiratory therapist (RT) care, making them a resource‐intensive therapy. Metered dose inhalers (MDIs) have been shown to be equally effective as nebs, but are commonly misused by patients. Therefore, administering unnecessary nebs is also a missed opportunity to educate patients on proper use of their MDIs. Eliminating inappropriate nebs and providing inpatient MDI education can improve care while lowering costs.

Purpose:

• To decrease neb usage in hospitalized patients on a high‐acuity medicine ward by at least 15%. • To provide inpatient education on proper MDI self‐administration. • To improve resident physician knowledge regarding the use of appropriate respiratory therapies.

Description:

We performed a needs assessment at a 600‐bed academic medical center and determined that we spent more than $1 million in direct costs for administration of nebs to non–intensive care unit (ICU) patients on the medicine service in fiscal year 2012. We averaged approximately 5 neb administrations per admission on our highest‐acuity medicine ward. In addition, to assess changes to house staff knowledge and attitudes regarding nebulizer and MDI use, we conducted pre‐ and postintervention surveys. We designed and implemented educational interventions and system changes to target inappropriate neb use and monitored neb administrations on the pilot unit, our highest‐acuity medical ward, to determine the impact. Our preliminary results demonstrate that overall neb usage and number of nebs administered per patient fell by more than 50% on the pilot unit following our initial interventions (Fig. 1). Prior to implementation, 49 of 74 eligible residents (66% response rate) completed the pretest, whereas 32 of 48 eligible residents (67%) completed the postintervention survey. At baseline, residents were aware that neb treatments are more expensive than MDIs (82% pretest; 94% postintervention; P = 0.11). Prior to the intervention 13 residents (26%) answered incorrectly that neb treatments are more efficacious than MDIs, in contrast to only 1 resident (3%) exposed to our intervention (P < 0.01). At baseline, none of the residents agreed that “patients receive adequate inpatient MDI teaching”; however, this improved to 16% after the first 2 months of implementation (P < 0.01).

Conclusions:

A multifaceted intervention has been successful in simultaneously decreasing unnecessary neb treatments, increasing MDI patient education, and improving evidence‐based resident physician knowledge. Reducing the use of resource intensive and unnecessary tests and treatments provides an ideal target for improving health care value.

Figure 1.Nebulized bronchodilator therapies (“Nebs”) delivered on a high‐acuity medical ward.

To cite this abstract:

Moriates C, Novelero M, Cascino M, Quinn K, Omachi T, Ranji S, Khanna R, Mourad M. Nebs No More After 24: Improving Use of Appropriate Respiratory Services. Abstract published at Hospital Medicine 2013, May 16-19, National Harbor, Md. Abstract 178. Journal of Hospital Medicine. 2013; 8 (suppl 2). https://www.shmabstracts.com/abstract/nebs-no-more-after-24-improving-use-of-appropriate-respiratory-services/. Accessed July 23, 2019.

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