Timely and Appropriate Transition From Small Volume Nebulizer Aerosol Delivery to Pressurized Metered-Dose Inhaler With Valved-Holding Chamber in the Hospitalized Patient

Background: Timely and appropriate patient transition from small volume nebulizer (SVN) to pressurized metered-dose inhaler (pMDI) with valved-holding chamber (VHC) is a barrier to medical center throughput and value-based respiratory care. During hospitalization, there are missed opportunities for long lasting respiratory care engagement of patients who are prescribed aerosolized bronchodilators via small volume nebulizer (SVN). Simultaneously, there could also be lasting benefits to offering timely patient education and follow-up regarding correct usage of a pMDI with VHC before hospital discharge. In the third quarter of fiscal year 2023, respiratory care service administered 6,094 aerosolized medications via SVN. Patient assessment conducted by respiratory care staff indicated that many of these patients could have received these treatments effectively via a pMDI with VHC. Methods: We implemented a fully respiratory care driven clinical pathway aimed at early identification, screening, and transition of patients prescribed aerosolized short-acting beta-adrenergic bronchodilators via SVN to receiving their treatment via a pMDI with VHC. Patients had an admitting diagnosis of acute and/or chronic bronchospastic airflow obstruction. To achieve consistency in navigating the clinical pathway we provided our respiratory care practitioners with comprehensive respiratory system assessment tools. Results: Our goal was to compare the number of prescribed SVNs and pMDIs with VHC in winter of FY 23 (pre-clinical pathway) to those prescribed in FY 24 (post-clinical pathway). In FY 23, there were 10,990 prescriptions for aerosolized short-acting beta-adrenergic bronchodilator to be delivered by SVN; an SVN to pMDI with VHC ratio of 146.5:1. In FY 24, there were more prescriptions for aerosolized short acting beta- adrenergic bronchodilators to be delivered by SVN, but with an increasing number of pMDI with VHC prescriptions, improving the ratio of SVN prescriptions to pMDI with VHC prescriptions to 70:1. Conclusions: While evidence supports equal efficacy of using a pMDI with VHC when compared to the SVN for bronchodilator administration, in-hospital adoption lags. Early implementation boosts patient confidence in pMDI use, cuts waste and cost, and enhances staff satisfaction and patient throughput.