(1292) Improving RT Efficiency in Delivery of Continuous Albuterol in Pediatric Asthma

Introduction: Inhaled albuterol is the cornerstone treatment of asthma. Our institution began administering Continuous Albuterol via Syringe Pump(CASP) with a vibrating mesh nebulizer in 2017. The medication was built into our Electronic Health Record(EHR) as a continuous medication infusion; therefore the medication was a High Risk Medication(HRM) and required an Independent Double Check Procedure(IDCP). The Institute for Safe Medication Practices(ISMP) defines an IDCP as a process when two clinicians independently check each component of prescribing, dispensing, and administering a medication based on the risk of the medication. Inhaled albuterol is not listed as a HRM by ISMP thus does not require IDCP. The EHR was requiring a co-signature to indicate an IDCP occurred with initiation and dose changes of CASP.

Methods: A single-center retrospective review of CASP administrations recorded in the Medication Administration Record(MAR) was conducted. Literature discussing IDCPs was evaluated, and benchmarking completed with 5 comparable children’s hospitals. National time standards were used to calculate median time required for cumulative MAR actions to assess time saved and calculate return on investment [10min x (average hourly rate/60]. Chi2 test performed to compare cost per administration.

Results: 7051 MAR actions were recorded pre-implementation (2/2/17-1/31/23) and 620 post-implementation(2/1/23-7/13/23). The most common MAR actions included New Bag(4849), Rate Verify(1731), and Missed(347). Literature was presented to the Medication Safety Committee resulting in the evaluation of CASP as a HRM and subsequent requirement for IDCP in January 2023. The requirement of co-signature for CASP was discontinued and deemed unnecessary. Cost of double verification for pre- and post-intervention period was $103,861vs $4,566, respectively. Estimating cost per administration of $14.73 pre-implementation with extra RT for verification. This results in a cost savings of $7.37 post-implementation for each administration with elimination of double verification (p=0.117).

Conclusions: The delivery of CASP is safe for patients with the use of preprogrammed infusion pump guardrails. Reducing double clinician check reduced unnecessary work on RT staff improving efficiencies and decreasing cost of care.