Parent-administered Metered-dose Inhalers Improves Medication Administration Time in the Children's Emergency.

Abstract

Introduction: Prompt administration of bronchodilator therapy via metered-dose inhalers (MDIs) is critical to optimizing clinical outcomes in children with bronchospasm. At our children's emergency department, baseline data indicated that the average interval between the first and second MDI bronchodilator cycles was 44.4 minutes, highlighting delays in bronchodilator therapy. The primary objective was to achieve a 30% reduction in the time interval between the first and second bronchodilator MDI cycles within 1 year.

Methods: This multidisciplinary quality improvement project was conducted using the Plan-Do-Study-Act model. Children aged 4-13 years presenting with clinical symptoms requiring bronchodilator therapy via MDI (salbutamol ± ipratropium) were included. Key interventions included revising the workflow to allow nurse-supervised parent administration of MDI, supported by information leaflets, educational videos, nurse-led demonstrations, competency checks, and a designated space for MDI administration. Our primary outcome measure was the time taken to administer the second cycle. Secondary outcome measures focused on parental competency and parent and nurse satisfaction.

Results: From August 2022 to June 2023, our educational program reduced the mean time to administer the second MDI cycle from 44.3 (SD 31.3) to 27.6 (SD 8.1) minutes (P < 0.001). Ninety-eight percent of parents were competent on their first attempt. Both parents and nurses reported high satisfaction with the initiative and perceived it as safe.

Conclusions: Parent-administered MDI significantly reduced the time interval between the first and second cycles and was highly accepted by parents and nurses, demonstrating an effective, sustainable approach to reducing delays in MDI administration in the emergency department.