Date of Award
12-2026
Degree Type
Dissertation/Thesis
Degree Name
Doctor of Nursing Practice (DNP)
School
Leadership and Advanced Nursing Practice
Committee Chair
Dr. Michong Rayborn
Committee Chair School
Leadership and Advanced Nursing Practice
Committee Member 2
Dr. Mary Jane Collins
Committee Member 2 School
Leadership and Advanced Nursing Practice
Abstract
Various methods of albuterol administration via pressurized metered-dose inhaler (pMDI), also referred to as a metered-dose inhaler (MDI), have been observed in the operating room (OR) and other perioperative settings. These observations prompted exploration of current best practices and guideline recommendations for optimized albuterol delivery to ventilated patients. A subsequent literature review revealed no environment-specific guidelines or recommendations that promoted safe, effective, and standardized albuterol administration during the perioperative period. Although guidelines for administering albuterol to adults via pMDI exist and can be followed in most settings, they do not address the unique challenges within perioperative settings. This quality improvement (QI) doctoral project conducted a gap analysis to identify potential barriers to adherence to existing guidelines and the consequent clinical practice variability.
Guided by the Knowledge-to-Action (KTA) Framework developed by Graham et al. (2006), a systematic literature review was conducted to identify current evidence-based practice (EBP) guidelines, recommendations, and potential gap themes associated with practice variability and suboptimal medication delivery. Barriers to standardized practice, as well as comparative evaluation of various delivery methods, including syringe-actuated pMDIs, in-line nebulizers, and pMDIs with spacers, with attention to their respective advantages and disadvantages, were explored in detail. Based on the literature review, an electronic survey was developed and distributed to Certified Registered Nurse Anesthetists (CRNAs) to assess educational, institutional, and resource-limited issues, ending with an optional additional comments section for participants. Survey analysis results confirmed the presence of current barriers, specifically notorious for disrupting best-practice outcomes. In addition to confirming current barriers, a table of recommended practice guidelines has been created as a reference for CRNAs, with consideration of conducive factors. This educational resource can be used to determine the best delivery method for pMDI administration when EBP guidelines cannot be met, based on available resources. Ultimately, this QI initiative aims to identify current contributing gaps, spread awareness, and promote future standardization.
ORCID ID
https://orcid.org/0009-0008-1140-703X
Copyright
Bisa S. Jennings and Shiane E. O'Neill, 2026
Recommended Citation
Jennings, Bisa S. and O'Neill, Shiane E., "Optimizing Albuterol Delivery: Quality Improvement Initiative For Perioperative Albuterol via Pressurized Meter Dose Inhaler Administration in Mechanically Ventilated Adult Patients" (2026). Doctoral Projects. 299.
https://aquila.usm.edu/dnp_capstone/299