Registered Respiratory Therapist Froedtert & MCW Milwaukee, Wisconsin, United States
Background: It was noted to clinic Respiratory Therapist (RT) by patients (Pt), they were having nebulizer machine and supply issues at a higher rate. Reports of not getting nebulizer cups every 6 months, or 2 per month if disposable, issues with proper cleaning and sterilizing of nebulizer kits and reports of low flow, loud noises or burn out of the nebulizer machine.
Methods: RT developed a questionnaire to gauge Pt knowledge on nebulizer care and supplies. During observation period, RT met with each Pt who had a nebulizer. Pt was asked age of their nebulizer machine and practices for cleaning/changing filters. They were also asked which durable medical equipment (DME) facility provided their neb kits and how often they were replaced. Pt was asked about their technique for cleaning/disinfecting the kits. Pt then received education on the expected life of a nebulizer machine, how improper filter maintenance can cause the machine to run inefficiently, hot and/or ruin the motor, leading to early replacement. Then was educated on proper hygiene on neb kits, risk that improper cleaning and disinfecting can cause bacteria build up, increasing infection possibility. Pt then was instructed on the proper technique for cleaning filters and cleaning/disinfecting neb kits. RT verified Pt had an active order for neb kit, and for those who had not received them regularly, contacted the patients DME to have neb kits dispensed. Pt was made aware that nebulizer orders are active for 12 months and received contact information for their DME for future communication. RT also provided suggestions on improving adherence with contacting their DME for new supplies. Example, if they had a smart phone to set a reminder on their calendar “order new neb kit” 6 months from the time they received the last one or use a paper calendar with the same notification every 6 months. Every Pt who received the education also received printed instructions, electronic availability if they had MyChart, for cleaning all equipment and disinfecting kits, plus contact information for their DME. RT then met with the Pt >5 months later to measure the impact on their post education state for knowledge of the machine maintenance and replacement of supplies.
Results: The Quality Improvement (QI) project started January 2021. Our center has 139 CF Pt, 93 had orders for nebulizers. Six Pt were correctly cleaning and disinfecting neb kits and proper care for filters (4.3%). Five Pt were not interviewed during the project (3.9%). Six (6.45%) Pt who were initially evaluated and educated, at follow-up reported no longer using nebulized medications. Thirty-two (34.4%)Pt were not available for the follow-up questionnaire. Of the remaining 55 Pt who were available for all QI steps: Twenty-six patients (27.95%)(47%) that had pre and post evaluation did not change their routine. Twelve (12.9%)(22%) reported cleaning/sterilizing/changing filters and neb kits as directed post education. Seventeen (18.28%)(33%) improved their cleaning/sterilizing/changing filters but still had some adherence issues.
Conclusions: Nebulizer care and maintenance represent an area for regular re-education for CF Pt. More than 51% of Pt received the education had measurable improvements in their understanding and care practices as the result of this education. Additional refinements in the education project will focus on providing DME contact information, education on the benefits for filter and neb kit replacement/maintenance, also discussing replacement reminder.
