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

Published online by Cambridge University Press:  04 March 2015

Barbara J. Hill-Taylor ,
Katrina F. Hurley ,
Ingrid Sketris ,
Colleen O'Connell ,
Douglas Sinclair  and
Andrew Wing
Barbara J. Hill-Taylor*
Affiliation:
IMPART, College of Pharmacy, Dalhousie University, Halifax, NS
Katrina F. Hurley
Affiliation:
Emergency Department, IWK Health Centre, Halifax, NS
Ingrid Sketris
Affiliation:
IMPART, College of Pharmacy, Dalhousie University, Halifax, NS
Colleen O'Connell
Affiliation:
IWK Health Centre, Halifax, NS
Douglas Sinclair
Affiliation:
St. Michael's Hospital, Toronto, ON
Andrew Wing
Affiliation:
Dalhousie Medical School, Dalhousie University, Halifax, NS
*
IMPART, College of Pharmacy, 1459 Oxford Street, Halifax, NS B3H 4R2; Barbara.Hill-Taylor@dal.ca

Abstract

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Objective:

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.

Keywords

asthma therapyclinical interventionhealth service researchpediatric emergency departmentsalbutamol inhalation
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 15 , Issue 2 , March 2012 , pp. 101 - 108
Copyright
Copyright © Canadian Association of Emergency Physicians 2013

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