Pressurized Metered-Dose Inhaler Extra Dispenses: Oh, the Horror!

Background: Metered dose inhaler (MDI) is one of the most common methods for inhalation medication administration in pediatrics and adults. The total annual spend associated with inhalers dispensed at our institution is $1,380,000 of that approximately 21% is due to replacing missing inhalers at the point of care. Upon investigation it was discovered that routine instances of missing inhalers were due to unstandardized storages areas, patient transfers, and change of shift. To decrease cost and improve efficiency, a team was established to verify and evaluate the problems and come up with solutions to improve practices around MDI administration. Methods: During the fall of 2017 a multidisciplinary team of respiratory therapists, pharmacists, pharmacy technicians, nurses, data analyst, and a process improvement advisor experts were brought together to evaluate the workflows around MDI administration throughout the hospital. The team developed a charter using the CHOP Improvement Framework to identify the biggest problem areas and develop actions for improvement. A series of PDSA cycles in three clinical areas targeting patient transfers, change of shift, and medication storage areas were introduced to test process improvement work. Results: Figure 1 illustrates the mean cost of having to dispense additional MDIs equals 21% of the total cost associated with MDI therapy. Creating a general awareness to the team before improvement work started, led to an initial 9. 7% reduction from the previous high of 25.9%. The first PDSA cycle focusing on hand-off and transfer communication led to a cost drop of 13. 7% of the total cost. The second PDSA cycle focused on the use of medication bags to standardize storage during patient transfer, this decreased the cost another percent to 12.7% of the total cost. Conclusions: Inhalation administration is a costly expense in healthcare organizations. Implementing simple systems aimed at improved communication around patient transfers and change of shift as well as standardizing storage methods can improve efficiency and decrease cost of delivering MDI therapy.