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Breathe in breathe out. Now what. Improved pediatric asthma outcomes through improved inhaler technique
  • Gina Nickels-Nelson, University of Texas at Tyler
Asthma is a chronic disease affecting families in the United States; especially pediatric patients aged 5-18. In Pittsfield, Massachusetts the local prevalence of asthma is 14.4% versus 12.1% statewide and 8.4% nationally. These patients miss school days thus causing parental workday loss. In 2016, 14.4 million missed school days occurred due to asthma (Alexander et al., 2016). Unexpected clinic visits, as well as emergency room visits due to asthma, can contribute to rising healthcare costs both locally and nationally. Unexpected asthma visits are a leading reason for visits to this author’s clinic.
Asthma is treated with inhaled medications through a metered dose inhaler. Proper use of this device is imperative for patients to achieve the best asthma control. Research has demonstrated that a lack of proper education and teaching of how to use an inhaler results in less than optimal outcomes. Furthermore, a review of the evidence indicated that most patients do not correctly utilize an inhaler, confirming that this leads to decreased medicine effectiveness and poor patient outcomes. At the author’s clinic, verbal inhaler technique education is provided but was not measured for effectiveness.
The Evidence-Based Practice process guided the Doctor of Nursing scholarly project. This project was solidly based on existing evidence to support improved outcomes in the asthma population. Therefore, the question arose, in pediatric patients with asthma, how does the addition of hands-on inhaler education compared to only verbal inhaler education affect inhaler technique, appropriate utilization of medications, clinic exacerbation visits, ER utilization, school attendance, and parent work attendance over a 3-month period of time?
Based on the evidence, the fundamental component of the scholarly project was to provide education to healthcare professionals so that they knew proper inhaler use and how to teach inhaler technique to patients. Following training of healthcare professionals, a protocol to consistently educate patients on correct inhaler technique was initiated. Planned outcomes for this project were improved inhaler technique and tightened asthma control. Outcomes that were planned but were unable to be measured were asthma exacerbation visits to both clinic and emergency room and missed school and parental work days. To evaluate these outcomes properly, ongoing quality improvement methods will be used. Sustainability of the Breathe In-Breathe-Out…Now What program will be contingent upon addressing lessons learned during the three months protocol implementation (Summer-Fall of 2018).
Publication Date
Citation Information
Gina Nickels-Nelson. "Breathe in breathe out. Now what. Improved pediatric asthma outcomes through improved inhaler technique" (2019)
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