Bronchodilator Abuse February 24, 2009
Posted by keepbreathing in Uncategorized.trackback
Today we have a special event: the very first Guest Post here at RT 101. Freadom, the mastermind behind The RT Cave, has agreed to write an article for me on bronchodilator abuse and the reasoning behind it while I resolve more technical issues here. So without further ado I present to you…
Many RTs, along with myself, have been on a crusade for bronchodilator reform. It is our humble goal to end bronchodilator abuse. By this we are not referring to asthma and COPD patients abusing their inhalers, but doctors ordering bronchodilator breathing treatments on patients who don’t need them.
Where I work there are no treatment protocols, so the problem is worse than at hospitals with protocols. Yet my RT friends who work at hospitals with protocols still complain to me about useless breathing treatments. Either it’s in the form of doctors overruling the protocol, or senior RTs who like to play it safe.
So it can be stated here that breathing treatment protocols seem to help, but do not end bronchodilator abuse.
Why is this? Because HMOs and THE government require certain procedures be ordered in order to meet criteria. If criteria is not met the hospital does not get paid.
Pneumonia is a great example. Some unwise person who has no clue what a bronchodilator even is decided that to for them to reimburse for the diagnosis of pneumonia, Q4-6 bronchodilator treatments need to be given.
The idea here is that if the patient isn’t sick enough to need a treatment he’s not sick enough to be in the hospital. Well, we humble RTs know this is ridiculous, but that’s the rule we have to live by. And that’s why our pneumonia protocol calls for Q4-6 Ventolin.
And this is why every single pneumonia patient has to be on Q4-6 Ventolin treatments regardless of whether or not they are having bronchospasm. When we are busy to begin with, this can be quality that could be spent with a person who REALLY needs the services of an RT.
Likewise, since 50% of patients admitted to hospitals are diagnosed with pneumonia, and many of them just because of this reimbursement criteria. That’s the only reason I can explain why so many patients diagnosed with pneumonia have clear lung sounds, a normal x-ray and labs.
The first step in ending bronchodilator abuse is educating folks that Ventolin is a bronchodilator and not a cure all for all annoying lung sounds and diseases. The second step is protocols.
The final step may be going beyond doctors and hospital administrators and finding your way to Washington on a quest to get Senators to pass laws (not that I like laws, but it was the government that caused this problem in the first place) banning Insurance companies and government agencies from setting quotas for reimbursement criteria.
Anyone up to the task?
Thanks, Freadom!
Excellent post. I went through this a few weeks ago with a doctor who I highly respect, but I think she was wrong on this one. She’s a MD/PharmD, so she should know better. Still she counseled me that Albuterol should be given to suspected pneumonia patients. First time I’d ever heard anyone who’s opinion I value tell me that, but she didn’t follow it with any science, as she usually does.
Do you remember about 15 years ago when Albuterol was supposed to be useful in CHF? That was a bust too, for much the same reason. Only in that case, it made the patients worse and wasn’t just not of benefit.
Thanks for the post, you made me feel better about my encounter.
urg. It really sucks to be the patient too. I’ve been in the ER with pneumonia a lot of time (more than I have fingers). Even though I tell them that a breathing treatment will only raise my heart rate, and I need some solumederal I get the “we have to give you 2 treatments before you can have the good stuff. GAH. Once I had to be admitted because after 4 treatments, my heart rate was way too high.
I knew I was going to love my pulmo when I got transfered to the big hospital with pneumonia and the first thing he said was “well we need to stop all those breathing treatments first thing”
I am a student respiratory therapist and have a background as a paramedic. I have, like many of you, asked what bronchodilators treat in the absence of bronchospasms. Again, like you I have not received an evidence/scientific based response. I am now designing a research project to address this situation for a required course in our program. If anyone has any idea where I can find similar research, I would appreciate your assistance.