[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-456235-105":3,"detail-sidebar-cat-0-en-105":81,"doc-detail-456235-en":130},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","rationale-and-strategy-for-switching-to-an-all-nebulization-protocol-for-in-hospital-administration-of-respiratory-medications","Rationale and Strategy for Switching to an All-Nebulization Protocol for In-Hospital Administration of Respiratory Medications","","Hospitalized patients with asthma or COPD often receive respiratory medications via inhalers or nebulizers, yet inpatient use of inhalers can create operational problems including formulary interchanges, administration and dosing errors, wasted medications, misplaced devices, unclear received doses, and increased costs. Switching to an all-nebulization strategy can streamline workflows and improve outcomes. Clinicians from multiple hospital systems describe how they implemented this transition, the benefits observed after rollout, and practical recommendations for successful operationalization and sustained performance.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/rationale-and-strategy-for-switching-to-an-all-nebulization-protocol-for-in-hospital-administration-of-respiratory-medications/456235/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/rationale-and-strategy-for-switching-to-an-all-nebulization-protocol-for-in-hospital-administration-of-respiratory-medications/456235.png","ImageObject",300,407,{"name":42,"@type":43},"Franzy","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-11-06","2026-09-30",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",9,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"Why do hospitals consider switching from inhalers to an all-nebulization protocol for inpatient use?","Question",{"text":63,"@type":64},"Hospitals face formulary interchange challenges, administration and dosing errors, unclear received doses, wasted drugs, misplaced devices, and higher costs with inpatient inhaler use. An all-nebulization approach can streamline processes and improve outcomes.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What operational benefits are reported after implementing all-nebulization protocols?",{"text":68,"@type":64},"The article reports improvements such as reduced therapeutic duplications and discharge discrepancies, along with significant cost savings, without negatively impacting length of stay, readmissions, patient satisfaction, or respiratory therapist visits per inpatient stay.",{"name":70,"@type":61,"acceptedAnswer":71},"What practical guidance does the article provide for implementing an all-nebulization strategy?",{"text":72,"@type":64},"The authors summarize operational learnings from multiple hospital systems and provide detailed recommendations for how to successfully switch to and operationalize all-nebulization protocols, based on firsthand experience.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},456235,1790820455,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,110,115,119,122,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":102,"doc_module":4,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},6,"Technology",50,"technology",{"id":107,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":108,"slug":109},7,40,"healthcare",{"id":111,"doc_module":4,"doc_module_name":25,"category_name":112,"show_sort_weight":113,"slug":114},8,"Research & Report",30,"research-report",{"id":55,"doc_module":4,"doc_module_name":25,"category_name":116,"show_sort_weight":117,"slug":118},"Religion & Spirituality",20,"religion-spirituality",{"id":117,"doc_module":4,"doc_module_name":25,"category_name":120,"show_sort_weight":117,"slug":121},"World Cup","world-cup",{"id":123,"doc_module":4,"doc_module_name":25,"category_name":124,"show_sort_weight":123,"slug":125},10,"Lifestyle","lifestyle",{"id":127,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":97,"slug":129},19,"General","general",{"code":4,"msg":82,"data":131},{"doc_id":79,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":4,"category_id":107,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":55,"language":139,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":12,"update_tm":143,"read_time":144,"preview_page_count":4},2336478945519,"https://ap-avatar.wpscdn.com/davatar_085a072bc5b1113ac321206ff7593b45","Rationale and Strategy for Switching to an All-Nebulization Protocol for In-Hospital Administration of Respiratory Medications  \nTrent Larson 1, Lexie Caraway2, Bobby Chasteen3, and Jason Glick4  \nAbstract  \nHospital Pharmacy  \n1–9 © The Author(s) 2026  \nArticle reuse guidelines:  \n[sagepub.com/journals-permissions](sagepub.com/journals-permissions)[ ](sagepub.com/journals-permissions)[DOI: 10.1177/00185787251403051](DOI: 10.1177/00185787251403051)[ ](DOI: 10.1177/00185787251403051)[journals.sagepub.com/home/hpx](journals.sagepub.com/home/hpx)  \nHospitalized patients with asthma or COPD typically receive respiratory medications via inhalers (pressurized metered dose inhalers, dry powder inhalers, or soft mist inhalers) or nebulizers. Because in-hospital use of inhalers may be complicated by required interchanges from nonformulary home inhalers to inpatient formulary inhalers, clinician or patient errors in administration, unclear dosage received, wasted drug, misplaced devices, and increased costs, switching from the use of inhalers to an all-nebulization strategy may streamline processes and improve outcomes. As respiratory therapists and hospital pharmacists, we have had experience with making this switch in different types and sizes of hospital systems. Despite the challenges we encountered, each of our approaches to implement an all-nebulization protocol was ultimately successful. In this article, we summarize our learnings during the operationalization of all-nebulization protocols, describe the benefits we observed post-implementation, and provide recommendations including detailed guidance for how to implement this type of switch successfully.  \nKeywords  \nasthma, chronic obstructive pulmonary disease, COPD, hospital formularies, inhalation devices, nebulizers, respiratory therapy  \nIntroduction  \nIn-hospital administration of respiratory medications typically involves the use of inhalers (pressurized metered dose inhalers [MDIs], dry powder inhalers [DPIs], or soft mist inhalers [SMIs]) or nebulizers for patients with asthma or COPD.1 As almost 40 different inhalers are currently marketed in the US,2 hospitals cannot realistically carry all of them, and streamlining those available may lead to additional complications. Several concerns exist regarding the use of MDIs and DPIs, such as improper use and difficulties in correct use resulting from patient impairment (cognitive, respiratory, or neuromuscular) or clinician error.3-6 For example, a cross-sectional study in a specialized respiratory inpatient unit found that nurses demonstrated \u003C50% competence with the usage of eight different inhaler devices, and none were able to demonstrate correct usage for all of the inhalers.3 These findings highlight the need for better training of nurses on the numerous inhalers being used, which is further complicated by high turnover rates among nursing professionals.  \nCost of wasted drug represents another concern associated with inhaler use, as most hospital stays are not long enough for patients to use the entire amount of drug in the device, especially as many inhalers are not produced in sizes suitable for institutional use.7 Several studies have illustrated the significance of this waste, which has been reported to be up to 87% of dispensed doses, with associated costs.7-10  \nInhaler use is also hampered by varied lung deposition of drug/dose delivered, as many patients could have inadequate respiratory muscle strength, leading to lowered peak inspiratory flow rates (PIFRs) that compromise the amount of drug inhaled.4,11 Furthermore, many hospitals do not routinely  \n1 Banner Health System, Phoenix, AZ, USA  \n2Clay County Hospital and Medical Clinics, Flora, IL, USA 3OU Health, Oklahoma City, OK, USA  \n4Dignity Health, Las Vegas, NV, USA  \nCorresponding Author:  \nTrent Larson, Banner Pharmacy Services, Banner Health System, Banner Corporate Center, Phoenix, AZ 85012, USA.  \nEmail: [trent.larson@bannerhealth.com](trent.larson@b","cbCairKZRK40mv4B","https://ap.wps.com/l/cbCairKZRK40mv4B","pdf",654621,"English","# Abstract\n# Introduction\n# Support for the Implementation of an All-Nebulization Strategy\n# Clinical Perspective","[{\"question\":\"Why do hospitals consider switching from inhalers to an all-nebulization protocol for inpatient use?\",\"answer\":\"Hospitals face formulary interchange challenges, administration and dosing errors, unclear received doses, wasted drugs, misplaced devices, and higher costs with inpatient inhaler use. An all-nebulization approach can streamline processes and improve outcomes.\"},{\"question\":\"What operational benefits are reported after implementing all-nebulization protocols?\",\"answer\":\"The article reports improvements such as reduced therapeutic duplications and discharge discrepancies, along with significant cost savings, without negatively impacting length of stay, readmissions, patient satisfaction, or respiratory therapist visits per inpatient stay.\"},{\"question\":\"What practical guidance does the article provide for implementing an all-nebulization strategy?\",\"answer\":\"The authors summarize operational learnings from multiple hospital systems and provide detailed recommendations for how to successfully switch to and operationalize all-nebulization protocols, based on firsthand experience.\"}]","Rationale and Strategy for Switching to an All-Nebulization Protocol for In-Hospital Administration of Respiratory Medications | PDF",1790745395,23]