Improving Inhaler Technique Education in a Pediatric Emergency Department

Abstract

Background: Efficacy of inhaled medications for asthma is dependent upon proper administration technique. Rates of metered dose inhaler and spacer misuse are high among both patients and healthcare providers, and gaps in patient education practices are widespread. Practice guidelines recommend patient technique be demonstrated and assessed at every encounter using a checklist of critical steps with repetition until competency is achieved. Local problem: The purpose of this project was to improve metered dose inhaler and spacer technique education provided by registered nurses in a pediatric emergency department. Nurses in this setting do not receive training on metered dose inhaler technique, and patient technique demonstrations are not routinely assessed or documented utilizing checklists. Interventions: All nurses working in the pediatric emergency department (n=20) received education on metered dose inhaler and spacer technique at the initiation of the project. Training checklists were developed and incorporated into the electronic medical record based upon practice guidelines. Prior to discharge, patients with asthma were asked by a nurse to demonstrate their technique using a metered dose inhaler and spacer. The nurse used the checklist in the patient’s electronic medical record to assess and document competency in the critical steps of metered dose inhaler and spacer technique. Instruction was provided by the nurses to remedy any patient errors until competency was demonstrated. Results: In patient chart audits conducted over a 10-week period 138 charts met audit criteria; 95 of which had documented checklists. One-hundred percent of patients and/or caregivers with documented checklists were able to demonstrate competency in all critical steps prior to discharge, with 35% requiring additional education to correct errors in technique. Conclusions: This project demonstrated the benefit of maximizing a pediatric emergency department encounter to provide evidence-based asthma education on a critical component of asthma management. Similar projects are needed that focus on inhaler technique in other settings, as well as with other inhalation devices.