The Science Journal of the American Association for Respiratory Care

2000 OPEN FORUM Abstracts

Evaluation of Healthcare Providers' Inhaler Technique

Baddar S1 RN, CRTT; Worthing E2 M.R. Pharm. S, M. Sc .Clin. Pharm; Al-Riyami B3 F.R.C.P, Ph.D; Al-Riyami K2 B. Pharm., M. Phil. Departments of Nursing1, Pharmacy2, Medicine3

INTRODUCTION
Inhaled medications are the cornerstone of asthma management worldwide. However, one adult and one pediatric study in Oman have confirmed poor inhaler technique amongst patients. The inhaler technique of healthcare providers in Oman has not been studied.
Objectives:
1. To assess the accuracy of inhaler technique of the most commonly used inhaler device (metered dose inhaler-MDI) amongst healthcare providers practicing in Oman.
2. To identify the most common problem steps of MDI technique.
METHODOLOGY
Design: A one year prospective study from December 1998 to November 1999 using a verbal questionnaire and inhalation demonstration.
Setting: Symposia on the management of asthma held in 5 regions of Oman.
Subjects: All health care providers attending a symposium who agreed to participate.
Verbal Questionnaire
The verbal questionnaire consisted of two questions:
1. Does participant counsel patients on the use of the prescribed inhaler?
2. Does participant prescribe inhalers for patients?
Inhaler Demonstration
Each participant was given a placebo MDI and asked to demonstrate one inhalation in front of an experienced respiratory therapist. The accuracy of inhaler technique was evaluated according to a structured checklist of sequential steps.
Date presentation and analysis: The eight inhaler steps were classified as either 'essential' or 'preferred'. A value of 'one' was assigned for every step performed correctly and 'zero' for every step performed incorrectly.
RESULTS
One hundred and fifty healthcare providers participated (107 physicians, 29 nurses, 10 Pharmacists and 4 other).
Verbal questionnaire:
148 (99%) participants counseled patients in inhaler technique of whom 107 (71%) also prescribed inhaler devices.
Inhaler Demonstration:
Result 1. Only 23 (15%) participants performed all MDI steps accurately. Accuracy of "first call" physicians in general practice and emergency medicine was only 5% and 9% respectively.
Result 2. The most common problem steps were a) shaking the canister before inhalation b) co-ordination of drug release and inhalation c) holding breath after inhalation.
CONCLUSIONS
- Most healthcare providers (85%) practicing in Oman do not demonstrate accurate MDI technique.
- Steps essential for drug delivery are frequently not performed correctly.
Every regional center should initiate, validate and audit training programs for doctors, nurses and pharmacists involved in the counseling of asthmatic patients.

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