Rationale and Strategy for Switching to an All-Nebulization Protocol for In-Hospital Administration of Respiratory Medications

Hospitalized patients with asthma or COPD typically receive respiratory medications via inhalers (pressurized metered dose inhalers, dry powder inhalers, or soft mist inhalers) or nebulizers. Because in-hospital use of inhalers may be complicated by required interchanges from nonformulary home inhalers to inpatient formulary inhalers, clinician or patient errors in administration, unclear dosage received, wasted drug, misplaced devices, and increased costs, switching from the use of inhalers to an all-nebulization strategy may streamline processes and improve outcomes. As respiratory therapists and hospital pharmacists, we have had experience with making this switch in different types and sizes of hospital systems. Despite the challenges we encountered, each of our approaches to implement an all-nebulization protocol was ultimately successful. In this article, we summarize our learnings during the operationalization of all-nebulization protocols, describe the benefits we observed post-implementation, and provide recommendations including detailed guidance for how to implement this type of switch successfully.