Instruction of Hospitalized Patients by Respiratory Therapists on Metered-Dose Inhaler Use Leads to Decrease in Patient Errors

BACKGROUND: Hospitalized patients have been shown to make several errors in using metered-dose inhalers (MDIs), which can lead to poor medication delivery.

METHODS: This study was designed to look at the potential benefit of a respiratory therapist (RT) giving instruction on the use of MDIs to hospitalized patients with obstructive lung disease. A baseline group of 58 patients was observed by a physician while performing 2 actuations of their MDI and the number of errors they committed, based on the National Institutes of Health's recommended 8 steps for proper MDI use, was recorded. After a program of MDI instruction (which included encouragement to use a spacer) by an RT was performed, a second group of hospitalized patients was again observed by a physician to determine if their error rate was reduced.

RESULTS: The baseline error rate was 6.72 (out of 15 possible) errors per patient, and improved to 2.43 errors per patient after RT-provided instruction (p < 0.001). This improvement was still significant after controlling for an increased use of spacers in the post-instruction group of patients (27.6% and 91.7% spacer use before and after education).

CONCLUSIONS: Instruction of hospitalized patients with obstructive lung disease by an RT improves their correct use of MDIs and increases their use of spacers while in the hospital.