Mixing and compatibility guide for commonly used aerosolized medications

Burchett, David K.; Darko, William; Zahra, James J; Noviasky, John; Probst, Luke A.; Smith, Alexis Nicole

doi:10.2146/ajhp080261

Cited by 18 publications

(8 citation statements)

References 12 publications

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“…47,48 Administration of bronchodilators before mucolytic administration is time-consuming, and research is lacking to establish safety, stability, and efficacy of admixtures using both agents. 53 Evidence suggests that there are opportunities to constrain health-care costs without incurring adverse health consequences. 54 The use of care paths, guidelines, and/or protocols provides caregivers with the opportunity to reduce unnecessary resource use and improve the value of care provided to patients by matching the therapy to patient need.…”

Section: Physical and Financial Harmful Effectsmentioning

confidence: 99%

AARC Clinical Practice Guideline: Effectiveness of Pharmacologic Airway Clearance Therapies in Hospitalized Patients

et al. 2015

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Aerosolized medications are used as airway clearance therapy to treat a variety of airway diseases. These guidelines were developed from a systematic review with the purpose of determining whether the use of these medications to promote airway clearance improves oxygenation and respiratory mechanics, reduces ventilator time and ICU stay, and/or resolves atelectasis/consolidation compared with usual care. Recombinant human dornase alfa should not be used in hospitalized adult and pediatric patients without cystic fibrosis. The routine use of bronchodilators to aid in secretion clearance is not recommended. The routine use of aerosolized N-acetylcysteine to improve airway clearance is not recommended. Aerosolized agents to change mucus biophysical properties or promote airway clearance are not recommended for adult or pediatric patients with neuromuscular disease, respiratory muscle weakness, or impaired cough. Mucolytics are not recommended to treat atelectasis in postoperative adult or pediatric patients, and the routine administration of bronchodilators to postoperative patients is not recommended. There is no high-level evidence related to the use of bronchodilators, mucolytics, mucokinetics, and novel therapy to promote airway clearance in these populations.

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Section: Physical and Financial Harmful Effectsmentioning

confidence: 99%

AARC Clinical Practice Guideline: Effectiveness of Pharmacologic Airway Clearance Therapies in Hospitalized Patients

et al. 2015

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“…Facility RT practice habits as they relate to mixing of nebulized medications should be ascertained as well. During our assessment, we determined that many RT departments were not maximizing their ability to combine nebulized solutions based on available published literature [44][45][46][47][48] . As a result, available information was provided to all RT directors in the system to facilitate improvements at their campus.…”

Section: Discussionmentioning

confidence: 99%

Economic impact and chronic obstructive pulmonary disease outcomes of a comprehensive inhaler to nebulization therapy protocol implementation in a large multi-state healthcare system

Larson

2019

Current Medical Research and Opinion

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Objective: There are currently 39 FDA-approved metered-dose (MDI) or dry-powder inhalers (DPI) on the US market. Most are high cost with significantly more drug in the device than needed for a typical average length of stay in acute care hospitals, which leads to significant waste. The objective was to assess the financial impact and chronic obstructive pulmonary disease (COPD) outcomes of a comprehensive inhaler to nebulization protocol implemented in a large multi-state US health system. Methods: The retrospective study evaluated respiratory drug costs at 28 hospitals in the health system after a phased implementation of the automatic inhaler to nebulization protocol. Purchasing data was collected for all respiratory medications impacted by the protocol for the twelve months preceding as well as the two subsequent twelve-month periods following implementation at each facility. COPD length of stay (LOS) and 30 day readmissions were also reviewed. An attempt was made to evaluate the impact on respiratory therapy (RT) department workload. Results: Compared to pre-implementation, system-wide drug expenditures declined $1,561,011 (38.5%) and $1,646,411 (40.6%) in post-implementation year 1 (PY1) and post-implementation year 2 (PY2), respectively. COPD LOS and 30 day readmissions were not adversely affected and remained relatively stable in comparative periods. Objective impact on RT productivity and labor statistics was not ascertained due to complicated variables and multiple service lines. Conclusions: In an era of increased drug costs incurred by hospitals, a comprehensive inhaler to nebulization protocol significantly decreased costs without incurring any negative observed trends in COPD LOS or readmissions.

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“…Before mixing solutions of various formulations in the nebulizer cup, however, the clinician must be certain that the combination is compatible. 112…”

Section: Nebulizer/formulation Combinationsmentioning

confidence: 99%

Aerosol Delivery Devices for Obstructive Lung Diseases

Pleasants

Hess

2018

Respir Care

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Drug delivery by inhalation is the principal strategy to treat obstructive lung diseases, which affect about 15% of the population in the United States. Aerosol delivery devices have evolved over more than 60 years from the basic pressurized metered-dose inhaler and nebulizer to numerous types of inhalers and devices, including valved holder chambers, dry powder inhalers, soft mist inhalers, as well as smart inhalers and nebulizers. Although these devices improve a patient's ability to self-administer medication, many problems with optimal delivery still exist. Appropriate selection and repeated patient education can help lessen the problems with these devices. Aerosol science is evolving, with methods of measurement that include radio-scintigraphy and magnetic resonance imaging, to provide a better understanding of aerosol delivery and effects. Understanding the science and clinical application of aerosol drug delivery can substantially aid clinicians in optimizing these therapies for their patients.

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Mixing and compatibility guide for commonly used aerosolized medications

Abstract: A compatibility guide for aerosolized medications was developed for use by staff who administer these agents.

Cited by 18 publications

References 12 publications

AARC Clinical Practice Guideline: Effectiveness of Pharmacologic Airway Clearance Therapies in Hospitalized Patients

AARC Clinical Practice Guideline: Effectiveness of Pharmacologic Airway Clearance Therapies in Hospitalized Patients

Economic impact and chronic obstructive pulmonary disease outcomes of a comprehensive inhaler to nebulization therapy protocol implementation in a large multi-state healthcare system

Aerosol Delivery Devices for Obstructive Lung Diseases

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