Quality Control of Inhalation Therapy

The Results of Therapy, with and without Control, and Methods of Developing Such Control, in a Community Hospital

¹ Medical Director, Respiratory Service, Sherman Oaks Community Hospital, and Associate Clinical Professor of Medicine, University of Southern California, Los Angeles

Deficiencies in quality of therapy in multiple areas, were demonstrated during a longterm surveillance program. Both training in and present methods of clinical monitoring were inadequate. One-third of patients were significantly under/over ventilated, pressures were used in a rote manner and respiratory rate control was lacking. Feedback to the physician was missing. These problems were correctable, once identified; example: reduction in incidence of tachypnea 21 to 8 percent and hypoventilation 27 to 14 percent. Correction required routine respiratory measurements, intensive inservice education, appropriate staff changes and improved physician liaison. Additionally, patients' actual ventilatory requirements must be established, in which physicians must become more directly involved. Finally, unless the quality of intermittent positive pressure breathing (IPPB) provided is uniformly maintained, there will be no way that response to therapy can be accurately assessed.