(1389) Evaluating Inhaler Technique and Educational Intervention Impact: A QI Project in Nursing Homes

Introduction: Chronic obstructive pulmonary disease is heterogenous lung condition characterized by progressive airflow obstruction causing dyspnea. Inhaled medications are most efficient standard route for delivering drugs to ensure increased efficacy and reduced side effects. Despite their widespread use, many patients lack knowledge of proper inhaler technique.

Methods: We conducted a QI project involving participants with COPD diagnosed according to GOLD criteria. Using guidelines from American Thoracic Society and Centers for Disease Control, we assessed patients' inhaler techniques. Our assessment comprised a two-part questionnaire: first part collected demographic, educational and disease severity information, while second part provided a checklist for evaluating inhaler technique. For intervention, we demonstrated proper inhaler use with actual devices, guiding through each step. We compared number of correct steps before and after intervention to evaluate its effectiveness.

Results: The study involved 53 patients (mean age 76.2; 20 males, 33 females). Initially, participants knew an average of 5.58 out of 9 inhaler technique steps, with 10 knowing all 9. Post-intervention, 28 patients knew all 9 steps, with average awareness reaching 9 steps. All patients who could perform steps correctly rated their confidence as 5/5. Technique improvement was 100%, with 53% achieving full correction. For those with fewer than 5 comorbidities, correct steps increased from 4.11 to 7.33; for those with more than 5 comorbidities, it rose from 5.8 to 9.4. Patients on fewer than 5 medications improved from 5.6 to 9.01 steps, while those on more than 5 raised from 5.5 to 9.01 steps. Commonly missed steps included shaking the inhaler, sealing around the mouthpiece, and rinsing mouth. Most patients were aware of removing the cap and inhaling correctly after intervention. Flyers were provided to all.

Conclusions: Our study shows that nursing home residents often lack knowledge of proper inhaler techniques despite prescriptions. Continuous education and reinforcement at each visit are essential. We are assessing staff inhaler techniques and the impact of educational interventions. The next step is to evaluate the long-term effects of this intervention on maintaining correct inhaler use and its impact on COPD exacerbations.