Natalie Paul, PharmD, BCPS, VP of Clinical Services for CPS, has co-authored an article – A Retrospective Review of an Inhaler to Nebulizer Therapeutic Interchange Program Across a Health System – published in the Journal of Pharmacy Practice, May 21, 2022.
Saint Alphonsus Health System (SAHS) hospitals implemented a metered dose inhaler (MDI) to nebulization therapeutic interchange program in which all orders for albuterol/ipratropium and inhaled corticosteroid/long-acting beta agonists (ICS/LABA) MDIs were therapeutically interchanged to nebulizers by the pharmacy.
Dr. Paul teamed with Megan E. LaCrone, PharmD, and Natalie Buening, PharmD, BCPS – both from St. Alphonsus Regional Medical Center in Boise, ID – to examine the primary outcome measure and assess the percentage of albuterol/ipratropium and ICS/LABA inhalers therapeutically interchanged to nebulized solutions.
Secondary outcomes included assessment of readmission rates, the percentage of patients discharged with the appropriate MDI, and a financial analysis of the implementation of the therapeutic interchange program.
The study was conducted between October 15, 2019 and February 15, 2020. It included adult patients with a history of asthma or COPD admitted to one of the SAHS hospitals with an order placed for ipratropium/albuterol, fluticasone/salmeterol, mometasone/formoterol, or budesonide/formoterol MDIs. Patients who were presumed to have or tested positive for COVID-19 were excluded from the study.
The first phase of implementing the SAHS inhaler to nebulizer therapeutic interchange program was operationally and clinically successful.
- Therapeutic interchanges successfully completed in 94.3% of all orders
- Discharge discrepancies occurred in 14.3% of orders assessed
- No correlation found between discharge discrepancies and 30-day readmissions
The MDI to nebulized solution interchanges saved almost $14,000 in medication costs in the sample population. The program is projected to continue to reduce medication waste and provide cost savings for SAHS.