Development of an inhaled medication administration protocol for intensive care practice

Abstract

Objective: To describe the development process of a protocol for the administration of inhaled bronchodilators contained in a pressurized metered-dose inhaler (pMDI) for patients undergoing invasive mechanical ventilation (MV). Methods: This is a qualitative, descriptive study of the experience report type. The theoretical-methodological framework was based on three national documents and one international document, from which key elements necessary for the creation of the construct were identified. The entire development process was conducted in five phases: 1) literature review, 2) construction of the protocol, 3) content and appearance validation, 4) methodological quality validation, and 5) publication of the protocol. Results: For the first phase, a scoping review was conducted, providing theoretical support for the main concepts related to the administration of bronchodilators contained in pMDIs during MV. The evidence obtained was synthesized and used to develop the construct. The protocol then proceeded to the phases of content, appearance, and methodological quality validation using previously validated evaluation tools, until satisfactory quality levels were achieved. The final document was structured with an introduction to the topic, recommendations, development, and application. Textual resources were used, followed by a flowchart with standard symbols and illustrations (static and with movement representation) as constituent elements of the construct. Conclusions: It is estimated that the developed protocol will provide support and recommendations to healthcare professionals for the correct administration of inhaled medications during IMV. Additionally, the description of the document development process may be useful to inform the creation of other documents focused on the administration/application of medications.