title: How to improve prescription of inhaled salbutamol by providing standardised feedback on administration: a controlled intervention pilot study with follow-up.
abstract: BACKGROUND
  The effectiveness of inhaled salbutamol in routine care depends particularly on prescribed dosage and applied inhalation technique. To achieve maximum effectiveness and to prevent drug-related problems, prescription and administration need to work in concert.
  
  
  METHODS
  We performed a controlled intervention pilot study with 4 consecutive groups in a general paediatric unit and assessed problems in salbutamol prescribing and administration. Control group [i]: Routine care without additional support. First intervention group [ii]: We carried out a teaching session for nurses aimed at preventing problems in inhalation technique. Independently from this, a pharmacist counselled physicians on problems in salbutamol prescribing. Second intervention group [iii]: Additionally to the first intervention, physicians received standardised feedback on the inhalation technique. Follow-up group [iv]: Subsequently, without any delay after the second intervention group had been completed, sustainability of the measures was assessed. We performed the chi-square test to calculate the level of significance with p ≤ 0.05 to indicate a statistically significant difference for the primary outcome. As we performed multiple testing, an adjusted p ≤ 0.01 according to Bonferroni correction was considered as significant.
  
  
  RESULTS
  We included a total of 225 patients. By counselling the physicians, we reduced the number of patients with problems from 55% to 43% (control [i] vs. first intervention [ii], n.s.). With additional feedback to physicians, this number was further reduced to 25% ([i] vs. [iii], p < 0.001). In the follow-up [iv], the number rose again to 48% (p < 0.01 compared to feedback group).
  
  
  CONCLUSIONS
  Teaching nurses, counselling physicians, and providing feedback on the quality of inhalation technique effectively reduced problems in salbutamol treatment. However, for success to be sustained, continuous support needs to be provided.
  
  
  BACKGROUND
  German Clinical Trials register: DRKS00006792 .
authors: Drug Safety Center, University of Leipzig, Leipzig, Germany. MartinaPatrizia.Neininger@medizin.uni-leipzig.de.|Department of Clinical Pharmacy, University of Leipzig, Leipzig, Germany. MartinaPatrizia.Neininger@medizin.uni-leipzig.de.
authors: Martina P
authors: MP
authors: Neininger
authors: Drug Safety Center, University of Leipzig, Leipzig, Germany. Almuth.Kaune@medizin.uni-leipzig.de.|Department of Clinical Pharmacy, University of Leipzig, Leipzig, Germany. Almuth.Kaune@medizin.uni-leipzig.de.
authors: Almuth
authors: A
authors: Kaune
authors: Department of Women and Child Health, Hospital for Children and Adolescents and Center for Pediatric Research, University of Leipzig, Leipzig, Germany. Astrid.Bertsche@medizin.uni-leipzig.de.
authors: Astrid
authors: A
authors: Bertsche
authors: Drug Safety Center, University of Leipzig, Leipzig, Germany. jessica.rink@gmx.de.|Department of Clinical Pharmacy, University of Leipzig, Leipzig, Germany. jessica.rink@gmx.de.
authors: Jessica
authors: J
authors: Rink
authors: Drug Safety Center, University of Leipzig, Leipzig, Germany. juliane_musiol@hotmail.de.|Department of Clinical Pharmacy, University of Leipzig, Leipzig, Germany. juliane_musiol@hotmail.de.
authors: Juliane
authors: J
authors: Musiol
authors: Drug Safety Center, University of Leipzig, Leipzig, Germany. Roberto.Frontini@medizin.uni-leipzig.de.|Pharmacy Department of the University Hospital Leipzig, University of Leipzig, Leipzig, Germany. Roberto.Frontini@medizin.uni-leipzig.de.
authors: Roberto
authors: R
authors: Frontini
authors: Department of Women and Child Health, Hospital for Children and Adolescents and Center for Pediatric Research, University of Leipzig, Leipzig, Germany. Freerk.Prenzel@medizin.uni-leipzig.de.
authors: Freerk
authors: F
authors: Prenzel
authors: Department of Women and Child Health, Hospital for Children and Adolescents and Center for Pediatric Research, University of Leipzig, Leipzig, Germany. Wieland.Kiess@medizin.uni-leipzig.de.
authors: Wieland
authors: W
authors: Kiess
authors: Drug Safety Center, University of Leipzig, Leipzig, Germany. thilo.bertsche@medizin.uni-leipzig.de.|Department of Clinical Pharmacy, University of Leipzig, Leipzig, Germany. thilo.bertsche@medizin.uni-leipzig.de.
authors: Thilo
authors: T
authors: Bertsche
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000328:Adult; D000420:Albuterol / Q000008:administration & dosage*; D001249:Asthma / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000193:education* / Q000592:standards*; D010371:Pediatric Nursing / Q000592:standards*; D010865:Pilot Projects; D017410:Practice Guidelines as Topic / Q000592:standards*; D055815:Young Adult
chemical_list: D001993:Bronchodilator Agents; D000420:Albuterol
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