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Thursday, August 7, 2008

Bronchodilator Reform: The Ventolin Pill

As I was traveling room to room the other day doing my breathing treatments, I couldn't help but get this funny feeling that only a few of the 20 patients on my list actually needed the breathing treatments.

Last night I had a little boy with asthma, and he did need them. I also have a COPD patient who might need them prn, but certainly not every four hours.

For the most part, I have come to the conclusion that about 80-90% of the breathing treatments that are ordered are for reason other than bronchospasm, and are thus not really indicated.

We have one doctor who orders Albuterol QID for all his post-op patients. We have a urologist who orders Albuterol on all his patients who develop Atelectasis or even if they simply develop a fever. And, of course, we have several doctors who order Albuterol Q4 for the diagnosis of pneumonia and CHF.

The funny thing is, none of these reasons are indications for Albuterol. Not only does the medicine not travel to the alveoli, it does not treat inflammation, which is what pneumonia is. It also does not absorb fluid or strengthen the heart.

One of the major concerns of our society is that the cost of health care is too expensive, especially for those who do not have health insurance. Hospital administrators are always looking for ways to cut back on overhead.

So, with this in mind, an epiphany struck me this morning.

Instead of having the doctors order breathing treatments that aren't indicated, and having the patient's insurance (or the patient if he has no insurance) have to pay the $88 per each non-indicated breathing treatment, why don't doctors simply order the Ventolin pill?

This pill would give the patient the same medicine, with the same result, at only a fraction of the cost, and a fraction of the manpower.

The hospital would benefit by not having to buy so much Ventolin ampules, and the RT would benefit because instead of getting burned out doing non-indicated therapies, he or she could spend quality time with the patients who truly need his or her services.

This would be a win-win situation for everybody.

For the non-acute patients with a history of asthma or COPD, they may benefit from having an MDI available on an as needed basis. We charge a fee for the MDI and the instruct, but the use of the inhaler when it is needed is free, or $88 less than a treatment.

This would be far better than giving them a treatment every four hours when they aren't even SOB.

Patients that actually shows signs of bronchospasm may still benefit from Albuterol nebulizers, but the rest can just get the Ventolin pill.

Personally, I don't think Ventolin should be used for anything other than bronchospasm (asthma, COPD, CF). But, if the doctor feels Ventolin is needed for some reason, let's start feeding these patients the pill.

That, my friends, it the Bronchodilator Reform idea of the day. Let me know your wisdom on this topic.


Jim and Sarah said...

I totally agree! I have the same exact problem at my hospital, and it would make so much more sense to use a pill for these "useless" treatments! Good idea! Now how do we market it to our docs??

Anonymous said...

Im an rt and i think u would be shooting yourself in the foot there are allready fewer and fewer rt jobs available and u havent considered the systemic effects that would be far greater than airosolized medicaton. As an rt who cant find a job right now i would love to do some so called useless hhn or mdi for that matter.

Rick Frea said...

Oh, all right! You make a good point!