title: Missed bronchodilator medication treatments in respiratory therapy: frequency and underlying causes.
abstract: BACKGROUND
  In the context of increasing attention to medical errors, missed therapies have become a subject of focus both for optimizing clinical care and for assuring appropriate institutional performance during external review by accrediting bodies. Because the issue of missed treatments in respiratory therapy has received little attention to date, we undertook to describe the frequency and causes of missed respiratory therapy bronchodilator medication treatments at the Cleveland Clinic Hospital.
  
  
  METHODS
  Between August 2000 and August 2001, using a respiratory therapy management information system, we recorded the number of respiratory therapy bronchodilator medication treatments ordered and delivered (via small-volume nebulizer and metered-dose inhaler) and the reason(s) for each missed treatment.
  
  
  RESULTS
  Over the 12-month study interval 113,554 bronchodilator medication treatments (74,921 via small-volume nebulizer and 38,633 via metered-dose inhaler) were ordered. Overall, 4,012 medication treatments were missed (3.5% of the total), with variation by month ranging from 2.0% to 5.0%. The commonest reason for failure to administer the ordered bronchodilator treatment was the patient being out of the room at the time of the therapist's visit, which accounted for nearly one third of missed therapies. Next most common was the patient refusing treatment (24.6%), followed by the patient being unavailable because of ongoing activities or therapy (eg, physical therapy or a medical procedure). The least common reason was the respiratory therapist being called away to administer therapy to another patient (1.4%).
  
  
  CONCLUSIONS
  Overall, the frequency of missed bronchodilator treatments was relatively low in this series. The next steps include developing strategies to lower the frequency of missed treatments, so as to optimize the allocation of respiratory therapy services, and studying the clinical consequences of missed therapies.
authors.affiliation: Department of Pulmonary and Critical Care Medicine, A 90, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland OH 44195, USA. stollej@ccf.org.
authors.forename: James K
authors.initials: JK
authors.lastname: Stoller
authors.forename: Douglas K
authors.initials: DK
authors.lastname: Orens
authors.forename: Lucy
authors.initials: L
authors.lastname: Kester
mesh_terms: D001993:Bronchodilator Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D008331:Management Information Systems / Q000706:statistics & numerical data; D008508:Medication Errors / Q000706:statistics & numerical data*; D009330:Nebulizers and Vaporizers / Q000706:statistics & numerical data; D010349:Patient Compliance / Q000706:statistics & numerical data; D012120:Respiration Disorders / Q000188:drug therapy*; D012124:Respiratory Care Units / Q000706:statistics & numerical data; D013997:Time Factors
chemical_list: D001993:Bronchodilator Agents