Inhalation technique practical skills and knowledge among physicians and nurses in two pediatric emergency settings

Abstract

Introduction: Correct technique with a pressurized metered-dose inhaler (pMDI) equipped with a valved holding chamber (VHC) or spacer provides an important advantage for adequate control of asthma and virus-induced wheezing in young children. The aim of this study was to assess the ability and knowledge of physicians and nurses to use a pMDI with a masked VHC in two pediatric emergency units.

Methods: Study design: Two-center observational study. Inhaler use technique was assessed in 50 physicians and 50 nurses using a child mannequin and a validated videotaped nine-step scoring method. The participants’ knowledge was evaluated by a questionnaire.

Results: The inhalation technique was perfectly mastered by 49% of the study participants and almost perfectly mastered by another 34% (mean score 8.3 ± 0.7; range 5–9). Nurses were more likely than doctors to demonstrate the technique perfectly (66% vs. 32%, p < 0.05). The two most common errors were forgetting to shake the pMDI between two consecutive puffs (38% of the participants) and putting the patient in an incorrect position (11%). About half of the participants reported that they checked each patient’s inhalation technique at every opportunity and knew how to clean the VHC. A large majority did not employ a reliable method to determine the amount of medication remaining in pMDIs without a counter.

Conclusion: Healthcare professionals’ practical skills and knowledge on inhalation therapy were not completely mastered and could be improved with a mandatory training program.

Keywords:

• Education
• treatment

Declaration of interest

The authors have no other competing interests to declare.

Acknowledgements

We give special thanks to all participants in this study and to Pierluigi Ballabeni for his statistical expertise.