How can inappropriate inhaler use be addressed in the chest patient ward with the help of the clinic pharmacist?

Comprehensive Work Plan for Addressing Inappropriate Inhaler Use in the Chest Patient Ward

A collaborative approach between ward staff and the clinic pharmacist is essential to effectively address inappropriate inhaler use, with the pharmacist serving as the inhaler therapy coordinator to implement education, assessment, and follow-up protocols.

Current Challenges with Inhaler Use

Inappropriate inhaler use is a significant clinical problem:

• Between 28% and 68% of patients do not use inhalers correctly enough to benefit from prescribed medications 1
• 39-67% of healthcare professionals (including nurses and doctors) cannot adequately perform or describe critical steps for inhaler use 1
• Of the estimated $25 billion spent annually on inhalers, $5-7 billion is wasted due to misuse 1

Proposed Work Plan Structure

1. Establish an Inhaler Therapy Coordination Team

• Designate the clinic pharmacist as the "inhaled therapy coordinator" responsible for producing and implementing local policies for inhaler therapy 2
• Form a multidisciplinary team including respiratory therapists, nurses, and physicians to support the coordinator
• Set regular meeting schedule (monthly) to review progress and address challenges

2. Assessment of Current Practice

• Conduct baseline assessment of:
  • Staff knowledge and skills with different inhaler devices
  • Patient technique and understanding of inhaler use
  • Current education protocols and materials
  • Inhaler device inventory and prescribing patterns
• Use standardized checklists to document common errors in technique
• Identify high-risk patients (elderly, low education level, living alone with spouse) who are more likely to misuse inhalers 3

3. Staff Education Program

• Implement formal training for all clinical staff on proper inhaler technique 2
• Create a tiered education approach:
  • Basic training for all ward staff
  • Advanced training for designated "inhaler champions" on each shift
  • Specialist training for the pharmacist coordinator
• Include hands-on practice with placebo devices for all inhaler types used in the ward
• Conduct quarterly refresher sessions to maintain skills
• Develop a competency assessment tool to verify staff proficiency

4. Patient Education Protocol

• Create standardized patient education materials covering 2:
  • Descriptions of equipment and proper use
  • Medication information (doses, frequencies, purpose)
  • Equipment maintenance and cleaning
  • Warning signs requiring medical attention
  • Emergency contact information
• Ensure first treatment is always supervised 2
• Implement teach-back method to verify patient understanding
• Record patient education in medical records

5. Inhaler Selection and Assessment Process

• Develop an algorithm for inhaler device selection based on:
  • Patient physical and cognitive abilities
  • Previous experience with inhalers
  • Disease severity and medication requirements
• Assess alternative delivery methods (MDI with spacer, dry powder inhaler) before prescribing nebulizers for home use 2
• Create a "trial" period for new devices to ensure patient capability 4

6. Follow-up and Monitoring System

• Establish a regular reassessment schedule for long-term inhaler users 2:
  • Initial follow-up at 1 month after starting treatment
  • Regular reassessment at least annually
• Assessment should include:
  • Technique demonstration using patient's own device
  • Lung function testing
  • Symptom control evaluation
  • Side effect monitoring
  • Equipment maintenance check
• Document reassessments in patient records

7. Equipment Management Protocol

• Create a system for:
  • Regular cleaning and maintenance of devices
  • Tracking of device age and replacement needs
  • Proper disposal of used equipment
• Ensure nebulizer equipment is cleaned regularly with warm water and detergent 2
• Implement infection control measures for shared equipment

8. Quality Improvement Process

• Collect data on:
  • Rate of correct inhaler technique among patients
  • Staff competency scores
  • Clinical outcomes (exacerbations, hospitalizations)
  • Patient satisfaction with inhaler education
• Review data quarterly to identify improvement opportunities
• Adjust protocols based on findings

Implementation Timeline

1. Month 1: Establish coordination team, conduct baseline assessments
2. Month 2: Develop education materials and protocols
3. Month 3: Conduct initial staff training
4. Month 4: Implement patient education protocol
5. Month 5-6: Conduct first round of patient reassessments
6. Month 7-12: Continue implementation with quarterly reviews

Role of the Clinic Pharmacist

The clinic pharmacist should:

1. Lead the inhaler therapy coordination team
2. Provide expert knowledge on inhaler devices and medications
3. Train staff on proper inhaler technique
4. Develop and maintain educational materials
5. Conduct patient assessments and follow-ups
6. Track outcomes and recommend protocol adjustments
7. Serve as the point person for inhaler-related questions

Common Pitfalls to Avoid

• Assuming staff knowledge: Even experienced healthcare professionals often lack proper inhaler technique 5
• One-time education: Single training sessions are insufficient; regular reinforcement is necessary
• Device mismatch: Not all patients can use all devices; selection should be personalized
• Neglecting follow-up: Technique deteriorates over time without reassessment
• Overlooking cleaning: Dirty equipment can lead to infections and reduced medication delivery

By implementing this comprehensive work plan, the chest patient ward can significantly improve inhaler technique among patients, enhance staff competency, and ultimately improve clinical outcomes while reducing wasted resources.