A quality improvement initiative to reduce excess inhaled therapy use in the neonatal intensive care unit

Objective: Inhaled medications are commonly used at our single-center, Level IV neonatal intensive care unit (NICU). We lacked a standardized process for measuring efficacy of these medications to guide optimal duration of use, potentially leading to their overuse. Methods: We utilized quality improvement methodology to reduce the length of inhaled hypertonic saline (HTS) course durations and high frequency albuterol use. Interventions included education, data sharing, and implementation of a respiratory therapy assessment tool. Results: The average inhaled HTS course duration decreased from 8.7 to 4.2 days. The percentage of q4 albuterol administrations per total albuterol doses administered monthly decreased from 39 to 20%. Conclusion: Developing a shared mental model between interprofessional providers for the indication and effect of inhaled agents and standardizing assessment of these medications’ efficacy can reduce their overuse.