scholarly journals Letter in response to: A Cost Analysis of Salbutamol Administration by Metered-Dose Inhalers with Spacers versus Nebulization for Patients with Wheeze in the Pediatric Emergency Department: Evidence from Observational Data in Nova Scotia

CJEM ◽  
2017 ◽  
Vol 19 (5) ◽  
pp. 410-410
Author(s):  
Mike Ballantine
Keyword(s):  
Emergency Department ◽  
Nova Scotia ◽  
Cost Analysis ◽  
Observational Data ◽  
Pediatric Emergency ◽  
Pediatric Emergency Department ◽  
Metered Dose Inhalers ◽  
Metered Dose

scholarly journals Evaluating a clinical practice intervention to promote delivery of salbutamol by metered-dose inhalers with holding chambers in a pediatric emergency department

CJEM ◽  
2013 ◽  
Vol 15 (02) ◽  
pp. 101-108 ◽  
Author(s):  
Barbara J. Hill-Taylor ◽  
Katrina F. Hurley ◽  
Ingrid Sketris ◽  
Colleen O'Connell ◽  
Douglas Sinclair ◽  
...  
Keyword(s):  
Emergency Department ◽  
Clinical Practice ◽  
Hospital Admissions ◽  
Pediatric Emergency ◽  
Pediatric Emergency Department ◽  
Inventory Data ◽  
Asthma Care ◽  
Hospital Admission Rate ◽  
Metered Dose ◽  
The Impact

ABSTRACTObjective:The primary objective of this study was to quantify the impact of a clinical practice intervention to promote the delivery of salbutamol by metered-dose inhaler (MDI) in a pediatric emergency department (PED). A secondary objective was to retrospectively document the components of the intervention.Methods:PED inventory data for salbutamol inhalation solution (nebules), MDIs, and holding chambers were obtained from the pharmacy department. Patient data were obtained fromthe hospital's decision support unit. Interrupted time series analysis was used to evaluate trends in salbutamol inventory data, patient triage acuity, and hospital admissions from January 1, 2003, to May 31, 2010. Interviews and administrative documents were used to identify components of the intervention, which began in 2006.Results:There was a 1,215% increase in the proportion of salbutamol delivered as MDIs compared to total inhaled salbutamol (MDI plus nebulization solution) following the intervention (95% CI 1,032% to 1,396%,p< 0.001). Increases in salbutamol MDI use were associated with the implementation of an institution-specific asthma care map. A relative decrease of 32% in the hospital admission rate (absolute –7.25%: 95% CI –8.31 to –6.19,p< 0.001) was associated with the change in salbutamol MDI use and the use of the asthma care map.Conclusions:A multifaceted intervention, designed and implemented by local PED clinical leaders, resulted in a pronounced change in salbutamol inhalation practice, with an associated decrease in admission rates. This intervention demonstrated many of the criteria for successful health system change. Findings from this research may be contextualized to inform change elsewhere.

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