Establishing a quality control program: ensuring safety from contamination for recycled metered-dose inhalers.

BACKGROUND: Recycling metered-dose inhalers (MDIs) is an effective method to conserve medications resulting in significant cost savings to the hospital. A noted limitation in some reports is the potential for cross-contamination. OBJECTIVE: To implement a quality control program to monitor and validate the safety of recycled MDIs for institutional reuse. METHODS: A quality control program was conducted from December 2012 to May 2013. At a 257-bed acute care facility, MDIs are administered to a single patient using a patient-specific valved holding chamber and then returned to the pharmacy for cleaning with 70% isopropyl alcohol prior to re-dispensing to a new patient. Ten percent of MDIs from 3 categories were categorized: prior to pharmacy cleaning, after pharmacy cleaning, and new/unused control group each month. The mouthpiece and canister spray tip from each MDI were tested. Any bacterial growth was documented. A secondary test was conducted to ensure that artificially contaminated MDIs could be cleaned with current cleaning procedures. Cost savings measures were also quantified. RESULTS: There was no bacterial growth on the 17 recycled MDIs cultured prior to the cleaning process. Bacteria did not grow on any of the 33 recycled MDIs cleaned with 70% isopropyl alcohol. Likewise, in the control group of 33 new/unused control MDIs, there was no bacterial growth. No bacteria growth was found after cleaning each artificially contaminated MDI. Total drug cost savings during the study period was approximately $130,000. CONCLUSIONS: Establishing a strict quality control program is paramount to validating a safe and effective recycled MDI procedure.

Evaluation of the use of bar-code medication administration in nursing practice using an evidence-based checklist.

The goal of this project was to determine whether the use of bar-code medication administration complied with current evidence as to how it should be used. Using an evidence-based checklist, we performed a gap analysis on bar-code medication administration (BCMA) in an acute care setting. Compliance with current evidence was identified through observation and unstructured nurse interviews. Based on findings from the initial gap analysis, quality improvement initiatives were implemented followed by a reassessment to identify possible improvement of the identified gaps. Initially, there was 72% compliance with current evidence-based practices using BCMA. After implementation of initial quality improvement initiatives targeting 3 of 9 areas with deficits in compliance, compliance was found to be 81%. The evidence-based checklist was helpful in identifying gaps in current performance and opportunities for improvement with BCMA.