1998 OPEN FORUM Abstracts
AUDIT OF METERED DOSE INHALER TECHNIQUES IN A RESPIRATORY CARE PROTOCOL PROGRAM
D. Haney RRT, Ed Hoisington, RRT, John Barkhart, BS, RRT, J. K. Stoller, M. D. The Cleveland Clinic Foundation, Cleveland, Ohio.
Introduction: Metered Dose Inhalers (MDI's) are widely used for inpatients at The Cleveland Clinic Foundation where 30,399 MDI's were administered in 1997. Within our Respiratory Therapy Consult Service (RTCS), patients (pts) are instructed in proper MDI use with allowance for patients to self-administer MDI's once they demonstrate proper technique. To assess whether patients retain the ability to use MDI's properly after RTCS "sign-off", we conducted this current audit. Methods: All patients using MDI's are instructed by the RTCS therapist with attention to proper dose, technique, and spacer use. An instructional handout is given routinely. For a convenience sample of patients assigned to MDI self-administration after demonstrating competent MDI technique, a therapist investigator re-assessed the patient's MDI technique 24 hours after "sign-off." A list of techniques was graded using a standard questionnaire assessing patients' ability to dispense canister, breath hold, pause between puffs, proper position and shaking of canister. Results: Of the 58 patients assessed, 91% had used MDI's at home before admission and 65% previously used a spacer. In all, 96% of patients administered the proper number of prescribed puffs, and 94% were aware of the proper frequency of administration. Also, 93% demonstrated the proper MDI technique with proper position and breath hold. On the other hand, 45% of these patients were unable to determine how much medication remained in the canister and 21% of patients did not recall receiving an instructional handout.
Conclusion: We conclude: 1. In this convenience sample, the rate with which patients retained proper MDI technique after previous sign-offs was high (>= 93%), suggesting that RTCS "sign-off" was generally appropriate. 2. However, more attention to instructing patients in some aspects of MDI use (i.e. detecting canister emptiness and the effects of their MDI medication) is needed.
The 44th International Respiratory Congress Abstracts-On-Disk®, November 7 - 10, 1998, Atlanta, Georgia.