50 Assessment of Inhaler Technique and Counselling
Outcome:
Accurate assessment of inhaler technique and individualised education for patients initiated on an inhaler to allow for safe and effective use.
Potential Risks:
Inaccurate or incomplete provision of information can lead to inappropriate use of the medication, potentially leading to patient harm.
Course
This EPA is undertaken in PHRM4071, PHRM4072 or PHRM4062.
Entrustment level
The anticipated entrustment level for PHRM4071, PHRM4072 or PHRM4062 is 2-3.
EPA Template:
Note: Printable EPA templates are available on course sites.
| Element | Performance Criteria Description |
|---|---|
| Introduction to Consultation | - Greet patient, establish patient identity, confirm time is convenient - Provide clear introduction to consultation, explaining your role and purpose of the consultation - Assess if carer/family member/translator needs to be present |
| Patient Background | - Clarify indication for inhaler therapy and likely duration of treatment (including follow up plan) - Assess concurrent medications for any potential drug-disease, drug-nutrient or drug-drug interactions (e.g. NSAIDs, beta blockers) |
| Communication Technique | - Evaluates patient’s baseline understanding e.g. current diagnosis, indication for inhalers and administration technique - Uses a balance of open and close-ended questions to obtain relevant information in a logical order - Uses appropriate language (i.e. non-judgmental, non-alarmist, jargon-free, reassuring) - Speaks with appropriate tone, volume and speed - Demonstrates sensitivity to specific cultural/social needs and beliefs of the patient |
| Provision of Information and Assessment of Inhaler Technique | - Explain disease state in layman terms if applicable - Explain correct indication for new or established inhaler(s), including reason behind any cessation of inhalers - Explain mechanism of action in layman terms if applicable (i.e. the difference between the roles of ‘reliever’ and ‘preventer’ inhaler) - Explain aim of therapy and identify likely duration of therapy - Correctly demonstrates inhaler administration technique to patient and/or carer, providing visual aids if needed (e.g. diagram/leaflets/videos) - Encourage and demonstrate the use of spacer where applicable - Evaluates patient and/or carer’s current understanding and ability to correctly demonstrate inhaler technique - Identify and educate patient on prescribed dose and frequency, including any dose changes to existing regimen - Discuss missed doses and what to do if this occurs - Reiterate importance of compliance as well as need to ensure that the ‘reliever’ is available at all times - Briefly summarise main points and provide patient with an opportunity to ask questions |
| Discuss Follow-Up and Action Plans | - Explain the need for ongoing regular follow up by GP and respiratory specialist if applicable - Explain the signs and symptoms to look out for if airways disease control is worsening - Provide patient with an Asthma Action Plan/COPD Action plan if appropriate |
| Cleaning and Storage of Inhaler Device | - Explain how to clean device and how often it should be cleaned - Explain storage requirements of inhaler (and if the inhaler must be carried at all times) |
| Lifestyle Factors | - Discuss any triggers for airways disease if applicable (e.g. allergies) - Assess smoking status and readiness to quit. Provide brief smoking cessation counselling for all smokers and organise provision of nicotine replacement therapy as inpatient or on discharge if applicable. |
| Adverse Effects | - Discuss common side effects and prevention if applicable (e.g. rinse mouth after use of inhaled corticosteroids) - Discuss other relevant adverse effects |
| Supply of Medication and Information | - Provide adequate supply of medication and suitable resources (e.g. CMI) - Explain to the patient how they will know when the inhaler has expired/run out of doses (e.g. dose window) - Discuss ongoing supply |
| Summary and Documentation | - Briefly summarise the main points and assess patient understanding by giving them opportunity to ask questions - Document education session clearly in the patient record and any arrangements for follow-up if applicable |
| Collaboration and Agency | - Clarification is sought for any concerns identified and escalated to an appropriate stakeholder - Identify and acknowledge any professional or personal limitations and seek support where necessary - Consultation is conducted in a professional, efficient and respectful manner |
