SHM Converge Scientific Abstract ePoster Gallery-Increasing Use of Metered-Dose Inhalers for Primary Inpatient Bronchodilator Therapy: A Single-Center Quality Improvement Project in the Covid-19 Era

Increasing Use of Metered-Dose Inhalers for Primary Inpatient Bronchodilator Therapy: A Single-Center Quality Improvement Project in the Covid-19 Era

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This single-center quality improvement project at a VA hospital aimed to increase use of metered-dose inhalers (MDIs) and reduce nebulizer (neb) use for inpatient bronchodilator therapy during the COVID-19 era. A multidisciplinary team of hospital medicine, pulmonology, respiratory therapy, and nursing staff designed the intervention. The SMART goal was to raise the proportion of patients receiving an MDI at any point during hospitalization from a baseline of 25% to 60% over one year.<br /><br />The team used VA Corporate Data Warehouse data and tracked both treatment-level and patient-level MDI vs. neb use. They implemented multiple Plan-Do-Study-Act cycles: staff education, nursing education, electronic health record order set changes favoring MDIs, and repeat COVID testing for patients requiring nebs. Improvement was assessed with descriptive statistics and statistical process control charts.<br /><br />Results showed substantial improvement. MDI use among all bronchodilator administrations rose from 8.6% in 2019 to 71.0% by the end of the fourth cycle. The percentage of patients receiving an MDI at any point during hospitalization increased from 26.8% to 82.1%. The shift away from nebs was associated with an estimated savings of 123 respiratory therapist hours per month. The greatest gains followed order set changes and repeat COVID testing requirements.<br /><br />Although MDI use later declined somewhat after the Delta wave, it remained higher than pre-intervention levels. The authors note that the project was conducted at a single center during the pandemic, and longer-term patient-level outcomes, outpatient fills, and readmissions were not yet analyzed.

Asset Subtitle

Joel C. Boggan

Meta Tag

Author List Ashley McKnight, Brian Schneider, Frank Bray, Govind Krishnan, Joel C. Boggan, Karen Welty-Wolf

Category Research

Concept Metered-Dose Inhaler

Concept Nebulizers

Concept Quality Improvement

Concept PDSA Cycle

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Distinguished Non-Finalist

Presenter Organization Durham VA Health Care System

Presenting Author Joel C. Boggan

Track Quality Improvement

Keywords

metered-dose inhaler

nebulizer

bronchodilator therapy

quality improvement

VA hospital

COVID-19

Plan-Do-Study-Act

electronic health record

respiratory therapy

statistical process control

Metered-Dose Inhaler

Nebulizers

Quality Improvement

PDSA Cycle

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