Correct Use Of A Metered Dose Inhaler: A Prospective Interventional Study Among Healthcare Professionals In A Nepalese Teaching Hospital
Dr. P.V. Kishore MD (Pulmonology), Associate Professor Department of Medicine, Manipal Teaching Hospital/ Manipal College of Medical Sciences, Pokhara, Nepal.
Background: Asthma and Chronic Obstructive Pulmonary Disease (COPD) are common in Nepal. Inhaled medications form the cornerstone of the management of these diseases. Metered Dose Inhalers (MDIs) are a common mode of delivering inhaled medications, and hence knowledge of the healthcare professionals regarding MDIs is the cornerstone for educating the patients about the correct use of MDIs.
Objectives: To study the correct use of MDIs by the doctors, nurses, pharmacists and medical interns, and to evaluate the impact of an educational intervention on the use.
Methods: A prospective, interventional study was carried out at the Manipal Teaching Hospital, Pokhara, Nepal. The subjects were asked to demonstrate the technique using a placebo inhaler, and the steps were graded as per the National Asthma Education and Prevention Program (NAEPP) criteria. Intervention was done by demonstrating correct MDI use with the help of placebo inhalers and an information leaflet. The post intervention response was analyzed using appropriate statistical tests.
Results: Altogether 143 health professionals (male 53.8%, female 46.1%) were studied prior to intervention, and 101 (male 41.5%, female 58.4%) of them in the post interventional phase. The overall mean Â± SD score obtained by the professionals was 4.44 Â± 2.07 (pre intervention), and 7.68 Â± 1.74 (post intervention). (P< 0.001, Z value - 10.020, Mann Whitney test). With regard to the individual scores of different categories of healthcare professionals, the scores for the nurses were 3.99 pre intervention and 8.14 post intervention, for doctors it was 5.96 and 7.18, for pharmacists it was 5.8 and 7.1, and for interns it was 4.72 and 7.12. None of the professionals could initially demonstrate all the ten steps involved in the correct use of MDI. Following the intervention one doctor, four medical interns, and eight nurses all demonstrated the steps correctly.
Conclusion: MDI use among healthcare professionals was poor before the intervention. The intervention was substantially effective in improving the technique.