15 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.
EPA Template:
| 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 |
