Prevent Errors With Nebulizer Solution Rxs

Mishaps are still occurring with nebulizer solutions.

In a recent case, a patient didn’t have a nebulizer machine at home...and ended up drinking salbutamol inhalation solution.

Work as a team to help prevent errors with nebs.

Product selection. Double-check med names, concentrations, and dosage forms when picking nebs from computer lists and shelves.

For example, salbutamol nebulizer solution comes in 1.25, 2.5, and 5 mg/2.5 mL nebules or ampoules...and 5 mg/mL bottles.

And budesonide nebs can be mistaken for budesonide caps, tabs, or inhaler...or ipratropium neb solution for ipratropium nasal spray.

Quantities and sigs. Clarify ambiguous or incomplete info on Rxs...to help prevent patient confusion and payer charge-backs.

For instance, a quantity of “60” could mean 60 vials or 60 mL.

Ensure “Via nebulizer” is in the Rx directions...and confirm patients have a nebulizer machine BEFORE they leave the pharmacy.

Storage. Check product labels for requirements.

For instance, tobramycin (Tobi) inhalation solution must be refrigerated before dispensing...but patients can store the amps in the fridge, or at room temperature for up to 28 days.

Dispense nebulizer solutions in their original packaging...the vials, amps, or nebs come in cartons or foil pouches to protect them from light.

Remind patients to also keep unused vials in this packaging...and to write down the “use by” date based on manufacturer specifications.

For example, salbutamol nebules expire 3 months after the foil pouch is opened.

See our resource, Dispensing Inhaled Medications, for more ways to avoid mishaps with nebulizers and inhalers.

Key References

  • ISMP Med Safety Alert! Community/Ambul Care 2022;21(9):1-6; AA1-AA3
  • https://www.medicare.gov/coverage/nebulizers-nebulizer-medications (1-3-23)
  • BMJ Open Respir Res. 2015 Feb 24;2(1):e000076
Pharmacy Technician's Letter Canada. January 2023, No. 390111



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