Impact of Targeted Bundles to Reduce the Nebulization Time Gap from Prescription to Administration among Red Triaged Patients in Emergency Department: An Quality Improvement Initiative

Background: Severe exacerbation of asthma are potentially life-threatening and therefore require prompt care and frequent management. Important aspects of early treatment includes recognition of early signs and symptoms of breathing difficulty and timely prescription and administration of therapeutic agents. A subsequent delay in receiving nebulization during an acute exacerbation of asthma can leads to cardiac arrest and even death. Aim: To reduce the gap in administration of nebulization from its prescription time among red triaged patients by 50% from its baseline. Setting and Design: This interventional study was conducted among red triaged patients in emergency department of tertiary care hospital, India. Material and Methods: Baseline information was collected during first 4 weeks to find gap in administration of nebulization from its prescription time. Fish bone analysis and process map were laid down to analyse the situation. The intervention using targeted bundles was done via 3 PDSA (PDSA1: indenting the nebulizers, PDSA 2: training of doctors and nurses, PDSA 3; introducing equipment checklist) to reduce the gap. A run chart using time series analysis model was used to compare the pre and post intervention nebulization gap. Results:  Total 74 patients (30 in pre- intervention, 44 in post intervention) admitted in red triaged area were observed for nebulization gap from prescription to administration. Median time for nebulization gap before intervention was 46.5 minutes which reduced to 15 minutes in post intervention phase. Conclusion: This bundles of targeted interventions was successful to reduce the nebulization gap.