title: Addition of levalbuterol to a pediatric emergency department automated medication management system does not increase its use.
abstract: BACKGROUND
  Although adding a drug to an emergency department-based automated medication management system is known to increase how frequently it is ordered, little is known about this effect when the added drug does not offer substantial benefit over a substitute drug that was already available.
  
  
  OBJECTIVE
  We studied the effect of adding nebulized levalbuterol to a pediatric emergency department-based automated medication management system that already included albuterol.
  
  
  METHODS
  All completed orders for nebulized levalbuterol or nebulized albuterol from our academic pediatric emergency department were retrospectively identified using a computerized pharmacy database. We compared ordering of these drugs for the year before levalbuterol was added to the automated medication management system, during which it was available only from the hospital central pharmacy via a pneumatic tube system, with the year following its inclusion in the system.
  
  
  RESULTS
  There were 6 orders for nebulized levalbuterol and 1,295 orders for nebulized albuterol during the year that levalbuterol was only available from the hospital central pharmacy, and 7 orders for nebulized levalbuterol and 1,108 orders for nebulized albuterol during the year following levalbuterol's inclusion in the automated medication management system. There was no significant difference (p = 0.78).
  
  
  CONCLUSIONS
  Use of nebulized levalbuterol, in relation to that of nebulized albuterol, for which it is a substitute, did not significantly change when it was included in the pediatric emergency department automated medication management system. This may reflect the lack of substantial benefit that levalbuterol offers over nebulized albuterol in managing children in the emergency department.
authors.affiliation: Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY, USA. gpconners@cmh.edu
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Conners
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Hays
authors.forename: Thomas
authors.initials: T
authors.lastname: Richardson
authors.forename: Frank L
authors.initials: FL
authors.lastname: Zwemer