Evaluation of Remote Patient Monitoring App for Spirometry Patients

Background: Prior to the COVID-19 pandemic, most patients were administered metered dose inhalers (MDI) using the common canister method at Sarah Bush Lincoln Health Center (SBLHC). During a quality review of processes, a multidisciplinary group estimated the cost of lost doses from budesonide/formoterol MDIs to be $50,255 annually. Despite concerns regarding aerosolized medication during a respiratory pandemic, it was decided SBLHC could safely administer nebulizers with filters and in-line, with proper personal protective equipment, and with negative pressure rooms. Methods: At admission, pharmacy automatically substituted all medications to nebulizers unless the provider chose an exemption reason. Results: Pharmacy ran reports of the total number budesonide/formoterol MDIs purchased and doses administered in 2018. This information as well as the estimated on-hand inventory were used to determine the estimated number of lost doses for 2018. Lost doses occurred when inhalers were accidently sent home with patients or spacers were unable to be utilized. Our calculations indicated an estimated loss of $50,255 annually due to lost doses. After implementing nebulized medications, pharmacy reviewed the same metrics and the estimated loss dropped to $310 annualized. A cost savings was also realized with the decreased usage of spacers at approximately $12,000 annually. Although most nebulized medications cost more per unit dose, the cost avoidance of lost doses of MDIs was still greater in this case and SBLHC saved approximately $31,400 annualized. Conclusions: It is important to periodically review processes to determine if the initial values have changed and how to make improvements based on available treatment options and practices. In this study, transitioning to nebulized medications improved patient safety by eliminating the chances of a common canister MDI being administered to the incorrect patient prior to appropriate reprocessing, decreased pharmacy technician work spent reprocessing MDIs, and saved money on spacers. Overall, transitioning to nebulizers was a substantial cost savings to the SBLHC health system. This study only reviewed budesonide/formoterol MDI due to the high cost and use of this medication, but additional cost savings can be assumed with transition of other various MDI’s to nebulized solutions including anticholinergics and short acting bronchodilators. This study was approved by the institutional IRB.