[Application of a hospital audit to the use of nebulizers: the Case of the Hôtel-Dieu de France-Lebanon]. / Application d'un audit hospitalier à l'utilisation de la nébulisation : l'exemple de l'Hôtel-Dieu de France-Liban.

ABSTRACT

PROBLEM: The aim of the study was to reduce the unjustified prescriptions of nebulised therapy, in order to comply with the international guidelines and to reduce healthcare costs. DESIGN: We performed a controlled, prospective study to evaluate the impact of local guidelines aimed at improving doctors' behaviour on appropriateness and costs of implementation. BACKGROUND AND SETTING: All the departments of a university hospital medical and surgical wards, intensive care units, emergency rooms and one-day admission units. KEY MEASURE FOR CHANGE Reduction in the number of inappropriate prescriptions of nebulised therapy. STRATEGIES FOR CHANGE Implementation included two educational presentations, posters displayed in all departments, emails sent to all doctors and residents, and reassessment of the prescription one week after. RESULTS: Prior to the intervention, the rate of inappropriate prescriptions was 11.9% (42/358 of patients treated with nebulizers did not have an indication for this treatment and 3/19 of patients had an indication for nebulisation but were not treated); in the postintervention, the rate of inappropriate prescriptions was 14.6% (15.7% of patients without indication for treatment, but no patient with an indication for treatment untreated), reflecting a lack of significant impact of the intervention. CONCLUSIONS: Simple presentation of clinical guidelines did not lead to a change in medical practices. Another approach is needed to improve this outcome effectively.