Education

PICU attendings and fellows: A single-subject journal club reviewed the use of mucolytics in non-CF intubated and noninvasively mechanically ventilated patients, including continuous and bilevel positive airway pressure (CPAP and BiPAP, respectively) and high flow nasal cannula. Description of the economic implications of using these medications on a unit-wide level demonstrated their strain and misuse. Subsequent clinical pathway postings encouraged all ICU practitioners to utilize the pathway as able.

Residents: Residents rotate through our unit every 4 weeks. At the start of each rotation, clinical pharmacists provided an orientation lecture that included a description of the mucolytic pathway and guidance on implementation.

Pharmacists and respiratory therapists: During patient care rounds, pharmacists inquired about the utilization of dornase alfa. They provided a review of the pathway, and they discussed cost with providers during order review as appropriate.

Respiratory Therapists: Often, respiratory therapists and nurses are the first to notice a significant change in secretions and are usually the first to suggest a mucolytic to a patient’s regimen. PICU respiratory therapy leadership was included in the pathway’s development and received ongoing encouragement for its use with the posting of the pathway in their workroom.