1
|
Neininger MP, Kaune A, Musiol J, Kiess W, Bertsche A, Prenzel F, Bertsche T. Handling Errors in the Use of Inhalation Devices: Inhalation Technique Skills and Knowledge in Pediatric Nurses. J Nurs Care Qual 2022; 37:180-187. [PMID: 34320513 DOI: 10.1097/ncq.0000000000000587] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Children suffering from bronchial diseases need assistance from nurses in the use of inhalation devices. PURPOSE We aimed to assess nurses' skills and knowledge concerning drug administration with inhalation devices in hospitalized pediatric patients. METHODS An expert panel defined medication errors in drug administration with inhalation devices in children. We monitored 241 inhalation procedures to investigate nurses' inhalation technique skills. Twenty-nine nurses completed a questionnaire to assess nurses' knowledge. RESULTS Skills: In 93 of 241 (39%) inhalation procedures, the mask/mouthpiece did not fit airtight. In none of the 11 inhalations administering a glucocorticoid, the patient's mouth was thoroughly cleaned afterward. Knowledge: Ten of 29 nurses (34%) thought a distance between mask and the patient's face was acceptable. Only 16 of 29 (55%) knew that it is necessary to thoroughly clean the patient's mouth after the inhalation of budesonide. CONCLUSIONS We found that education on inhalation procedures including practical training is required to increase patient safety.
Collapse
Affiliation(s)
- Martina Patrizia Neininger
- Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University and Drug Safety Center, Leipzig University and University Hospital, Leipzig, Germany (Drs Neininger and T. Bertsche and Mss Kaune and Musiol); University Hospital for Children and Adolescents, Center for Pediatric Research, Leipzig, Germany (Drs Kiess, A. Bertsche, and Prenzel); and Neuropediatrics, University Hospital for Children and Adolescents, Rostock, Germany (Dr A. Bertsche)
| | | | | | | | | | | | | |
Collapse
|
2
|
Maricoto T, Santos D, Carvalho C, Teles I, Correia-de-Sousa J, Taborda-Barata L. Assessment of Poor Inhaler Technique in Older Patients with Asthma or COPD: A Predictive Tool for Clinical Risk and Inhaler Performance. Drugs Aging 2020; 37:605-616. [PMID: 32602039 DOI: 10.1007/s40266-020-00779-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND/OBJECTIVES Older patients with asthma or chronic obstructive pulmonary disease (COPD) are particularly susceptible to inhaler technique errors and poor clinical outcomes. Several factors may influence their risk, but most studies are inconsistent and contradictory. We developed a tool for the major predictors of individual risk in these patients. DESIGN, SETTING AND PARTICIPANTS In this multicentre, cross-sectional study, several demographic, socioeconomic and clinical characteristics were collected as potential predictors. Clinical features and inhaler technique performance were the main outcomes. Linear and logistic regression models were set up to identify significant variables. Subgroup analysis was performed according to age, cognitive performance and different types of inhalers. RESULTS We included 130 participants, mean age of 74.4 (± 6.4) years. Mean years of device use were 5.8 (± 7.3). Inhaler errors affected 71.6% (95% CI 64-78.5) and critical mistakes 31.1% (95% CI 24-38.8). There were respiratory comorbidities in 82.3% of participants, and 56.2% had moderate to severe disease. A predictive score of misuse probability was developed for clinical practice, including points attributable to cognitive score, adherence and having received previous education on a placebo device. Other significant variables of individual risk were having respiratory allergies or comorbidities, smoking status, depression and educational level. Worse performance was detected in cognitively impaired patients older than 75 years who were using dry powder inhalers (DPI). Lung function was associated with smoking load, incorrect dose activation and absent end pause after inhalation. CONCLUSIONS Individual risk assessment in older individuals should focus on inhaler technique performance (mainly on dose activation and end pause) and adherence, smoking, respiratory comorbidities and cognitive impairment. Placebo device training provided by doctors seems to best suit these patients.
Collapse
Affiliation(s)
- Tiago Maricoto
- Aveiro-Aradas Family Health Unit, Aveiro Healthcare Centre, Aveiro, Portugal.
- Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal.
- USF Aveiro-Aradas, Praceta Rainha D. Leonor, 3800, Aveiro, Portugal.
| | - Duarte Santos
- Aveiro-Aradas Family Health Unit, Aveiro Healthcare Centre, Aveiro, Portugal
| | - Catarina Carvalho
- Flor de Sal Family Health Unit, Aveiro Healthcare Centre, Aveiro, Portugal
| | - Inês Teles
- Flor de Sal Family Health Unit, Aveiro Healthcare Centre, Aveiro, Portugal
| | - Jaime Correia-de-Sousa
- Life and Health Sciences Research Institute (ICVS)/3B's-PT Government Associate Laboratory, University of Minho, Braga, Portugal
- Horizonte Family Health Unit, ULS Matosinhos, Matosinhos, Portugal
| | - Luís Taborda-Barata
- CICS-Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
- CACB-Clinical Academic Center of Beiras, Covilhã, Portugal
- Department of Allergy and Clinical Immunology, Cova da Beira University Hospital Centre, Covilhã, Portugal
| |
Collapse
|
3
|
Olivera CMX, Vianna EO, Bonizio RC, de Menezes MB, Ferraz E, Cetlin AA, Valdevite LM, Almeida GA, Araujo AS, Simoneti CS, de Freitas A, Lizzi EA, Borges MC, de Freitas O. Asthma self-management model: randomized controlled trial. HEALTH EDUCATION RESEARCH 2016; 31:639-652. [PMID: 27473571 DOI: 10.1093/her/cyw035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 06/25/2016] [Indexed: 06/06/2023]
Abstract
Information for patients provided by the pharmacist is reflected in adhesion to treatment, clinical results and patient quality of life. The objective of this study was to assess an asthma self-management model for rational medicine use. This was a randomized controlled trial with 60 asthmatic patients assigned to attend five modules presented by a pharmacist (intervention group) and 59 patients in the control group. Data collection was performed before and after this 4-month intervention and included an evaluation of asthma knowledge, lifestyle, inhaler techniques, adhesion to treatment, pulmonary function and quality of life. An economic viability analysis was also performed. The intervention group obtained an increase in asthma knowledge scores of 58.3-79.5% (P < 0.001). In this group, there was also an increase in the number of individuals who practiced physical exercise (36-43%), in the number of correct replies regarding the use of inhalers, in the percentage of adherent patients, and in quality of life scores for all domains. We concluded that this asthma self-management model was effective in improving the quality of life of asthma patients.
Collapse
Affiliation(s)
- Carolina M X Olivera
- Department of Pharmaceutical Sciences, Pharmacy School, Ribeirão Preto 14040-903, Brazil
| | | | - Roni C Bonizio
- Department of Accounting, School of Economy, Administration and Accounting, Ribeirão Preto 14040-905, Brazil
| | | | - Erica Ferraz
- Department of Medicine, Medical School, Ribeirão Preto 14049-900, Brazil
| | - Andrea A Cetlin
- Department of Medicine, Medical School, Ribeirão Preto 14049-900, Brazil
| | | | | | - Ana S Araujo
- Department of Medicine, Medical School, Ribeirão Preto 14049-900, Brazil
| | | | - Amanda de Freitas
- Department of Social Medicine, Medical School, Ribeirão Preto 14049-900, Brazil and
| | - Elisangela A Lizzi
- Department of Mathematics, Federal University of Technology, Curitiba, 80230-901, Brazil
| | - Marcos C Borges
- Department of Medicine, Medical School, Ribeirão Preto 14049-900, Brazil
| | - Osvaldo de Freitas
- Department of Pharmaceutical Sciences, Pharmacy School, Ribeirão Preto 14040-903, Brazil
| |
Collapse
|
4
|
Ari A, Fink JB. Differential Medical Aerosol Device and Interface Selection in Patients during Spontaneous, Conventional Mechanical and Noninvasive Ventilation. J Aerosol Med Pulm Drug Deliv 2016; 29:95-106. [DOI: 10.1089/jamp.2015.1266] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Arzu Ari
- Division of Respiratory Therapy, Georgia State University, Atlanta, Georgia
| | - James B. Fink
- Division of Respiratory Therapy, Georgia State University, Atlanta, Georgia
| |
Collapse
|
5
|
Giner J, Roura P, Hernández C, Torrejón M, Peiró M, Fernández MJ, de Santa María EL, Gimeno MA, Macian V, Tarragona E, Plaza V. Knowledge and Attitudes of Nurses in Spain about Inhaled Therapy: Results of a National Survey. J Aerosol Med Pulm Drug Deliv 2016; 29:86-93. [DOI: 10.1089/jamp.2014.1198] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jordi Giner
- Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomédica Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Department of Medicine, Barcelona, Spain
| | - Pere Roura
- Service of Clinical Epidemiology, Hospital General de Vic, Barcelona, Spain
| | - Carme Hernández
- Integrated Care Unit, Medical and Nursing Direction, Hospital Clínic, IDIBAPS, CIBER de Enfermedades Respiratorias (CIBERES), Universitat de Barcelona, Spain
| | - Montserrat Torrejón
- Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomédica Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Department of Medicine, Barcelona, Spain
| | - Meritxell Peiró
- Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomédica Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Department of Medicine, Barcelona, Spain
| | - M Jesús Fernández
- Lung Management Area, Central University Hospital of Asturias, Oviedo, Spain
| | | | - M Angeles Gimeno
- Service of Pneumology, Hospital de Palamós, Palamós, Girona, Spain
| | - Vicente Macian
- Service of Pneumology, Hospital Arnau de Vilanova, Valencia, Spain
| | - Eduard Tarragona
- Medical Advisor of Medical Department Chiesi, L'Hospitalet del Llobregat, Barcelona, Spain
| | - Vicente Plaza
- Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomédica Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Department of Medicine, Barcelona, Spain
| |
Collapse
|
6
|
Oliveira PDD, Menezes AMB, Bertoldi AD, Wehrmeister FC, Macedo SEC. Assessment of inhaler techniques employed by patients with respiratory diseases in southern Brazil: a population-based study. J Bras Pneumol 2015; 40:513-20. [PMID: 25410839 PMCID: PMC4263332 DOI: 10.1590/s1806-37132014000500007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 08/15/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE: To identify incorrect inhaler techniques employed by patients with respiratory
diseases in southern Brazil and to profile the individuals who make such errors.
METHODS: This was a population-based, cross-sectional study involving subjects ≥ 10 years
of age using metered dose inhalers (MDIs) or dry powder inhalers (DPIs) in 1,722
households in the city of Pelotas, Brazil. RESULTS: We included 110 subjects, who collectively used 94 MDIs and 49 DPIs. The most
common errors in the use of MDIs and DPIs were not exhaling prior to inhalation
(66% and 47%, respectively), not performing a breath-hold after inhalation (29%
and 25%), and not shaking the MDI prior to use (21%). Individuals ≥ 60 years of
age more often made such errors. Among the demonstrations of the use of MDIs and
DPIs, at least one error was made in 72% and 51%, respectively. Overall, there
were errors made in all steps in 11% of the demonstrations, whereas there were no
errors made in 13%.Among the individuals who made at least one error, the
proportion of those with a low level of education was significantly greater than
was that of those with a higher level of education, for MDIs (85% vs. 60%; p =
0.018) and for DPIs (81% vs. 35%; p = 0.010). CONCLUSIONS: In this sample, the most common errors in the use of inhalers were not exhaling
prior to inhalation, not performing a breath-hold after inhalation, and not
shaking the MDI prior to use. Special attention should be given to education
regarding inhaler techniques for patients of lower socioeconomic status and with
less formal education, as well as for those of advanced age, because those
populations are at a greater risk of committing errors in their use of
inhalers.
Collapse
|
7
|
Neininger MP, Kaune A, Bertsche A, Rink J, Musiol J, Frontini R, Prenzel F, Kiess W, Bertsche T. How to improve prescription of inhaled salbutamol by providing standardised feedback on administration: a controlled intervention pilot study with follow-up. BMC Health Serv Res 2015; 15:40. [PMID: 25627678 PMCID: PMC4314799 DOI: 10.1186/s12913-015-0702-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 01/13/2015] [Indexed: 11/30/2022] Open
Abstract
Background The effectiveness of inhaled salbutamol in routine care depends particularly on prescribed dosage and applied inhalation technique. To achieve maximum effectiveness and to prevent drug-related problems, prescription and administration need to work in concert. Methods We performed a controlled intervention pilot study with 4 consecutive groups in a general paediatric unit and assessed problems in salbutamol prescribing and administration. Control group [i]: Routine care without additional support. First intervention group [ii]: We carried out a teaching session for nurses aimed at preventing problems in inhalation technique. Independently from this, a pharmacist counselled physicians on problems in salbutamol prescribing. Second intervention group [iii]: Additionally to the first intervention, physicians received standardised feedback on the inhalation technique. Follow-up group [iv]: Subsequently, without any delay after the second intervention group had been completed, sustainability of the measures was assessed. We performed the chi-square test to calculate the level of significance with p ≤ 0.05 to indicate a statistically significant difference for the primary outcome. As we performed multiple testing, an adjusted p ≤ 0.01 according to Bonferroni correction was considered as significant. Results We included a total of 225 patients. By counselling the physicians, we reduced the number of patients with problems from 55% to 43% (control [i] vs. first intervention [ii], n.s.). With additional feedback to physicians, this number was further reduced to 25% ([i] vs. [iii], p < 0.001). In the follow-up [iv], the number rose again to 48% (p < 0.01 compared to feedback group). Conclusions Teaching nurses, counselling physicians, and providing feedback on the quality of inhalation technique effectively reduced problems in salbutamol treatment. However, for success to be sustained, continuous support needs to be provided. Trial registration German Clinical Trials register: DRKS00006792.
Collapse
Affiliation(s)
- Martina P Neininger
- Drug Safety Center, University of Leipzig, Leipzig, Germany. .,Department of Clinical Pharmacy, University of Leipzig, Leipzig, Germany.
| | - Almuth Kaune
- Drug Safety Center, University of Leipzig, Leipzig, Germany. .,Department of Clinical Pharmacy, University of Leipzig, Leipzig, Germany.
| | - Astrid Bertsche
- Department of Women and Child Health, Hospital for Children and Adolescents and Center for Pediatric Research, University of Leipzig, Leipzig, Germany.
| | - Jessica Rink
- Drug Safety Center, University of Leipzig, Leipzig, Germany. .,Department of Clinical Pharmacy, University of Leipzig, Leipzig, Germany.
| | - Juliane Musiol
- Drug Safety Center, University of Leipzig, Leipzig, Germany. .,Department of Clinical Pharmacy, University of Leipzig, Leipzig, Germany.
| | - Roberto Frontini
- Drug Safety Center, University of Leipzig, Leipzig, Germany. .,Pharmacy Department of the University Hospital Leipzig, University of Leipzig, Leipzig, Germany.
| | - Freerk Prenzel
- Department of Women and Child Health, Hospital for Children and Adolescents and Center for Pediatric Research, University of Leipzig, Leipzig, Germany.
| | - Wieland Kiess
- Department of Women and Child Health, Hospital for Children and Adolescents and Center for Pediatric Research, University of Leipzig, Leipzig, Germany.
| | - Thilo Bertsche
- Drug Safety Center, University of Leipzig, Leipzig, Germany. .,Department of Clinical Pharmacy, University of Leipzig, Leipzig, Germany.
| |
Collapse
|
8
|
Oliveira PDD, Menezes AMB, Bertoldi AD, Wehrmeister FC. Inhaler use in adolescents and adults with self-reported physician-diagnosed asthma, bronchitis, or emphysema in the city of Pelotas, Brazil. J Bras Pneumol 2014; 39:287-95. [PMID: 23857689 PMCID: PMC4075837 DOI: 10.1590/s1806-37132013000300005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE: To evaluate the characteristics of users of inhalers and the prevalence of inhaler use among adolescents and adults with self-reported physician-diagnosed asthma, bronchitis, or emphysema. METHODS: A population-based study conducted in the city of Pelotas, Brazil, involving 3,670 subjects ≥ 10 years of age, evaluated with a questionnaire. RESULTS: Approximately 10% of the sample reported at least one of the respiratory diseases studied. Among those individuals, 59% reported respiratory symptoms in the last year, and, of those, only half reported using inhalers. The use of inhalers differed significantly by socioeconomic status (39% and 61% for the lowest and the highest, respectively, p = 0.01). The frequency of inhaler use did not differ by gender or age. Among the individuals reporting emphysema and inhaler use, the use of the bronchodilator-corticosteroid combination was more common than was that of a bronchodilator alone. Only among the individuals reporting physician-diagnosed asthma and current symptoms was the proportion of inhaler users higher than 50%. CONCLUSIONS: In our sample, inhalers were underutilized, and the type of medication used by the individuals who reported emphysema does not seem to be in accordance with the consensus recommendations.
Collapse
|