Pre‐procedure

ActionRationale

1. 1.Show
   Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed.
   To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [144], C).
2. 2.Show
   Ask the patient what their best peak flow measurements have been and what their current peak flow readings are.
   To enable a comparison to be drawn between their current and previous results (British Thoracic Society [30], C).
3. 3.Show
   Wash and dry hands or use alcohol‐based handrub.
   To minimize the risk of cross‐infection (NHS England and NHSI [124], C).
4. 4.Show
   Assemble the equipment. Ask the patient to use their own meter if it is in good working order and less than 1 year old. If using a multiple‐patient device, ensure that it is valved and has a disposable single‐use mouthpiece.
   Different equipment can have slight variations in results; therefore, using the same equipment will allow a reliable comparison (Dakin et al. [50], E). However, regular use causes the spring to become slack and so the meter may become inaccurate if it older than 1 year (Hill and Winter [82], E).

   To prevent cross‐infection (NICE [127], Weston [211], E).
5. 5.Show
   Ask the patient to adopt the position in which they normally undertake the procedure; this can be either standing or sitting. They should be advised not to flex their neck.
   In order that their maximal lung volume can be reached and so that there is no positional obstruction that could affect the results, and to enable comparisons between results (Peate and Wild [157], E).
6. 6.Show
   Push the needle on the gauge down to zero.
   To ensure the results are accurate (Hill and Winter [82], E).

Procedure

1. 7.Show
   Ask the patient to hold the peak flow meter horizontally, ensuring their fingers do not impede the gauge.
   So that the movement of the needle is not obstructed (Hill and Winter [82], E).
2. 8.Show
   Ask the patient to take a deep breath in through their mouth to full inspiration.
   To ensure they achieve the greatest measurement (NICE [135], E).
3. 9.Show
   Ask the patient to immediately place their lips tightly around the mouthpiece. The inspiration should be held for no longer than 2 seconds at total lung capacity.
   To ensure a good seal around the mouthpiece and to prevent the patient's tongue and teeth from obstructing it (NICE [137], E).

   To ensure the full, total lung capacity is held. E
4. 10.Show
   Ask the patient to blow out through the meter in a short, sharp ‘huff’ as forcefully as they can. See Action figure 14.36.
   This can be very quick and need only take about 1 second, to enable accuracy of results (British Thoracic Society [30], E).
5. 11.Show
   Take a note of the reading and return the needle on the gauge to zero. Ask the patient to take a moment to rest and then repeat the procedure twice, noting the reading each time. Ideally there should be less than 20 L/min difference between the three readings. If there is more than 40 L/min difference, two additional blows can be performed. Document the highest of the three acceptable readings.
   To ensure that the best possible result is achieved (Hill and Winter [82], E).

Post‐procedure

1. 12.Show
   Document the readings on the patient's record chart, comparing measured values against predicted values or patient trends. Report any abnormalities to medical or senior nursing staff.
   Records must be kept of all assessments, treatment and care, and the outcomes of these (NMC [144], C).
2. 13.Show
   Dispose of the mouthpiece (unless using the patient's own) and clean the meter in line with local policies and the manufacturer's recommendation.
   To prevent the risk of cross‐infection (NICE [127], Weston [211], E).
3. 14.Show
   Wash and dry hands and/or use an alcohol‐based handrub.
   To minimize the risk of cross‐infection (NHS England and NHSI [124], C).