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Research Letter |

“Nebs No More After 24”: A Pilot Program to Improve the Use of Appropriate Respiratory Therapies

Christopher Moriates, MD1; Maria Novelero, MA, MPA1; Kathryn Quinn, MPH1; Raman Khanna, MD1; Michelle Mourad, MD1
[+] Author Affiliations
1Department of Medicine, University of California, San Francisco, San Francisco
JAMA Intern Med. 2013;173(17):1647-1648. doi:10.1001/jamainternmed.2013.9002.
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Nebulized bronchodilator therapies (“nebs”) are commonly used in the inpatient setting for the treatment of obstructive pulmonary symptoms. Nebs have equal efficacy when compared with metered-dose inhalers (MDIs) for patients with obstructive pulmonary symptoms13 but are significantly more costly because they need to be directly administered by a respiratory therapist (RT). Unnecessary neb administration in the hospital also represents a missed opportunity to educate inpatients on proper use of their MDIs. Press et al4 found that while 86% of patients incorrectly administered their prescribed MDI, all were able to achieve mastery following instruction.

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Figure.
Multifaceted Intervention and Nebulizer Rates on a High-Acuity Medical Ward

Our intervention was associated with a significant decrease in nebulizer rates (as measured per month and normalized by total admissions) on a pilot medical ward. MDI indicates metered-dose inhaler; neb, nebulized bronchodilator therapy; RT, respiratory therapist.

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