inhaler and spacer teach

candidate brief

You are discharging your patient home on a salbutamol MDI. They have requested for you to teach them how to use it with a spacer.

mostly from geekymedics

Introduction

  • Wash your hands, introduce yourself
  • Confirm the patient's name and date of birth
  • Check the patient's current understanding
  • Ask the patient if they have any pain or shortness of breath

Explanation

  • Explain what an inhaler is and how they work
  • Explain when this inhaler should be taken (e.g. regular vs PRN)

Demonstration of correct technique with explanations

  • Holding the device upright, remove the cap from the inhaler and inspect closely to make sure there is nothing inside the inhaler mouthpiece
  • Shake the inhaler well for roughly 5 seconds (explain this is to mix the medication)
  • If using a spacer, demonstrate how to attach this correctly and ensure if there is a valve it is facing upwards
  • Advise the patient they should be sat or stood up straight with their chin slightly tilted upwards to improve distribution into the lungs
  • Advise the patient that should breathe out gently and slowly away from the inhaler until they feel their lungs empty
  • Explain importance of tight seal between the mouthpiece and lips
  • Instruct the patient to start to breathing in slowly and deeply through their mouth.
  • Demonstrate pressing the inhaler canister to co-ordinate with the breath (pMDI), or breathing slowly and steadily into the device 5 times (spacer)
  • (no spacer) Explain they should continue to breathe in slowly until their lungs feel full, then remove the inhaler from their mouth and tightly seal their lips
  • (no spacer) Explain the importance of breath holding to allow the medication to settle in the lungs; advise breath holding for 10 seconds, or as long as they are comfortable
  • Explain they should breathe out slowly and gently away from the inhaler and replace the cap
  • If a second dose is required, the patient should wait 30 seconds to a minute before repeating the previous steps
  • Highlight the importance of cleaning the inhaler/spacer and making sure the cap is always replaced on the inhaler/spacer after use
  • Ask the patient to demonstrate the technique back to you using their own inhaler
  • Provide feedback to allow the patient to refine their technique
  • Invite questions
  • Explain the potential side effects of salbutamol
  • Advise that if the patient has an asthma attack that does not respond to their salbutamol inhaler after 10 puffs (with 30 seconds between each puff) they should call 999
  • Provide an information leaflet for the relevant inhaler device
  • Safety netting advice
  • Global mark from patient

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