![]() However, others did not know how to use any of their MDI devices correctly. Much of the problem centered around patient misinformation about treating their disease.įor example, RTs had identified patients using multiple rescue inhalers in a row before finally deciding to seek care at the hospital. Part of their rationale for the policy was that if the patient’s MDIs were working as they should, the patient most likely should not have ended up in the hospital with an acute exacerbation. “Otherwise, the home med list of MDIs is converted by pharmacy physician-approved protocol to the nebulizer equivalent.” “Our policy was all patients will receive nebulizer treatments while in the facility unless the patient brings their home MDI and the physician agrees to continue that use of said MDI,” said Matt Nolan, MBA, BSRC, RRT, RRT-NPS, RRT-ACCS, director of cardiopulmonary and neurodiagnostics. Texas Health Resources Southwest Fort Worth was already delivering respiratory treatments primarily by nebulizers before the pandemic hit. None of the cases were linked to patients who received AGPs under our care.”Īdvertisement Sticking with the status quo “Only a few of our staff have had COVID over the past year. “We provided extensive education with our RT, nursing, physician, and leadership about how we were safely and effectively administering nebulized medications,” Caraway said. Staff in and out of respiratory care were well educated on the factors involved as well. Patients received their nebulizer treatments in negative pressure rooms, and additional rooms were added as COVID-19 cases surged in their area. In addition, all nebulizers were breath actuated, and each nebulizer was filtered. In their case, they ensured all staff members had adequate PPE, including N-95s, gowns, and PAPRs. ![]() “To date, all medications are nebulized at our facility, with a few exceptions, including patients on our behavioral health unit and patients who refuse nebulizers and wish to provide their own home MDI.”Ĭaraway believes nebulization can be performed safely in hospitals with the proper precautions. But, ultimately, it was decided that we needed to do what we felt was best for our patients,” she said. “Some physicians and nursing staff voiced their concerns about these aerosol-generating procedures and others such as the use of high flow oxygen. ![]() By October of last year, the hospital reinstated the nebulization option.Ĭaraway says she is proud of her staff for stepping up to speak for patients in need, even when others in the hospital were still wary of the change. Nebulization was considered a better option for these patients, and the staff went to bat for their patients in advocating for a return to the previously decided-upon policy. “Many of our regular COPD patients were not relieved of their shortness of breath and did not have the strength and/or coordination to activate the inhalers they were receiving,” she said. “In the beginning of the pandemic, we worked with pharmacy to order additional MDIs and transition all medications to non-aerosolizing medications in an effort to protect our staff,” Caraway said.Īs the months wore on, however, the general feeling of the RT staff was that MDIs were not delivering enough medication to patients who needed it. The decision to switch to nebulizers came from a multidisciplinary team that reviewed new medications, processes, and options on the market. The common canister program was implemented about eight years ago as a cost-saving measure. “Prior to the pandemic, we used common canisters for MDIs and also administered nebulizers,” said Lexie Caraway, MBA, RRT, RRT-NPS, RRT-ACCS, AE-C, manager of respiratory therapy. The Sarah Bush Lincoln Health System in Mattoon, IL, was beginning to explore the switch to nebulization when the pandemic hit. Is it safe to use nebulizers in the hospital setting during a global pandemic spread by respiratory means? Three RTs share their experiences. Now with more than a year of pandemic experience under their belts, some hospitals are rethinking that move. As a result, many hospitals that had previously switched from MDIs to nebulization for in-patients to improve care and save on costs discontinued those programs. Nebulization has particularly been called into question. Still, for respiratory therapists, the debate surrounding aerosol-generating procedures (AGPs) has probably been one of the biggest. The pandemic has raised many safety issues related to the delivery of patient care. Guidance Document - RRT Entry to Licensure.Coding, Billing and Reimbursement Issues.Early Professional Membership for Students.
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