Evaluation of Stocking Continuous Albuterol in Automated Dispensing Cabinets on Operational and Clinical Outcomes in a Pediatric Emergency Department

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Abstract
Purpose: Evaluate operational and clinical outcomes of stocking continuous albuterol syringes in the emergency department (ED) automatic dispensing cabinet (ADC) for pediatric patients with moderate to severe asthma exacerbations. Methods: Retrospective chart review evaluating patients who received continuous albuterol 10 mg/hr in a pediatric ED before and after stocking in the ED ADC. The primary outcome is the time to first dose initiation from pharmacist verification. The secondary outcomes include hospital length of stay (LOS), duration of continuous albuterol, ED disposition, change in Pediatric Asthma Scores (PAS) from baseline, or rates of treatment failure. Results: Baseline demographics were well balanced between the two groups, with the exception that the pre-implementation group had a higher rate of Hispanic/Latino ethnicity (20.7% vs 8.9%, p=0.04). For the primary outcome, the post-implementation group had a decreased time for initiation of first dose of continuous albuterol from verification (47.3 vs 14.7 minutes, p<0.001). There were no differences were seen between hospital LOS, duration of continuous albuterol, ED disposition, rates of treatment failure, the reason for treatment failure, or change in PAS from baseline. No issues were documented with stocking the continuous albuterol syringes in the ED ADC in the post-implementation group. Conclusion: Proactively stocking continuous albuterol syringes in a pediatric ED ADC reduced the time from pharmacist verification to dose initiation by almost 70%. There were no changes to other operational or clinical outcomes. Further studies are needed to determine the clinical and operational impacts of stocking continuous albuterol syringes or other emergent medications in an ED ADC.

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