Metered-dose inhalers: do emergency health care providers know what to teach?

Abstract

Study objective: To evaluate the ability of emergency health care providers and patients to demonstrate the proper use of metered-dose inhalers (MDIs).

Design: Prospective cross-sectional survey.

Setting: Five Midwestern community teaching hospitals.

Participants: One hundred eighty-five health care providers, comprising emergency medicine house staff (n = 60), attending emergency physicians (n = 50), and ED nurses (n = 75). Also recruited were 100 consecutive ED patients with clinical history of asthma being treated with at least one MDI for more than 3 months.

Interventions: We surveyed patients and health care providers to assess their knowledge of and ability to use a conventional MDI. The subject's technique of using a placebo inhaler was graded by a trained observer using a checklist of six essential steps.

Results: Forty-one percent (76 of 185) of health care providers and 49% (49 of 100) of ED asthma patients performed at least five steps correctly (P = .24). There were no significant differences in performance scores among the emergency medicine house staff (42%), attending emergency physicians (34%), and ED nurses (45%). Only 15% of all health care providers and 17% of asthma patients were able to describe how to estimate the amount of medicine left in the canister.

Conclusion: These results suggest that many patients use MDIs improperly. Emergency physicians, house staff, and nurses responsible for instructing patients in optimal inhaler use may lack even rudimentary skills with these devices.