title: The conversion to metered-dose inhaler with valved holding chamber to administer inhaled albuterol: a pediatric hospital experience.
abstract: BACKGROUND
  Metered-dose inhalers with valved holding chambers (MDI-VHCs) have been shown to be equivalent to small-volume nebulizers (SVNs) for the delivery of bronchodilators in children. At Seattle Children's Hospital and Regional Medical Center we sought to implement the conversion from SVN to MDI-delivered albuterol in nonintubated patients receiving intermittent treatments.
  
  
  METHODS
  There were 4 distinct interventions used to plan and implement this conversion program: (1) literature review, (2) product selection, (3) policy and operational changes, and (4) staff training. Bronchodilator administration guidelines and clinical pathways for asthma and bronchiolitis were revised to recommend MDI-VHC use in lieu of SVNs. Computerized physician order sets were amended to indicate MDI-VHC as the preferred method of delivering inhaled albuterol in children with asthma and bronchiolitis. Data from administrative case mix files and computerized medication delivery systems were used to assess the impact of our program.
  
  
  RESULTS
  MDI-VHC utilization increased from 25% to 77% among all non-intensive-care patients receiving albuterol, and from 10% to 79% among patients with asthma (p < 0.001). Duration of stay among patients with asthma was unchanged after conversion to MDI-VHC (p = 0.53).
  
  
  CONCLUSIONS
  Our program was very successful at promoting the use of MDI-VHC for the administration of albuterol in our pediatric hospital. Duration of stay among patients with asthma did not change during or since the implementation of this program.
authors.affiliation: Department of Respiratory Care, Children's Hospital and Regional Medical Center, 4800 Sandpoint Way NE, Seattle WA 98105, USA. john.salyer@seattlechildrens.org
authors.forename: John W
authors.initials: JW
authors.lastname: Salyer
authors.forename: Robert M
authors.initials: RM
authors.lastname: DiBlasi
authors.forename: Dave N
authors.initials: DN
authors.lastname: Crotwell
authors.forename: Charles A
authors.initials: CA
authors.lastname: Cowan
authors.forename: Edward R
authors.initials: ER
authors.lastname: Carter
mesh_terms: D000280:Administration, Inhalation; D000420:Albuterol / Q000008:administration & dosage*; D001249:Asthma / Q000188:drug therapy; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D002648:Child; D003365:Costs and Cost Analysis; D004867:Equipment Design; D006776:Hospitals, Pediatric; D006801:Humans; D007902:Length of Stay; D036501:Metered Dose Inhalers / Q000191:economics; D009330:Nebulizers and Vaporizers; D016730:Program Development; D012139:Respiratory Therapy Department, Hospital; D014861:Washington
chemical_list: D001993:Bronchodilator Agents; D000420:Albuterol