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 (Griffith and Jordan [110], E; NMC [257], C).
2. 2.Show
   Wash hands with bactericidal soap and water or an alcohol‐based handrub.
   To minimize the risk of cross‐infection (DH [64], C; Fraise and Bradley [98], E).
3. 3.Show
   Carefully explain and demonstrate the inhaler to the patient. If further advice is required, contact the hospital pharmacist.
   Correct use of inhalers is essential (see the manufacturer's information leaflet). Incorrect use may result in most of the dose remaining in the mouth and/or being expelled almost immediately. This renders treatment ineffective (Watt [362], E).

Procedure

1. 4.Show
   Assist the patient into an upright position, if possible in the bed or a chair.
   To permit full expansion of the diaphragm. E
2. 5.Show
   Before administering any prescribed drug, look at the patient's prescription chart and check the following:

   1. the correct patient is being given the drug
   2. drug
   3. dose
   4. date and time of administration
   5. route and method of administration
   6. diluent as appropriate
   7. validity of prescription
   8. signature of prescriber
   9. the prescription is legible.
   To ensure that the correct patient is given the correct drug in the prescribed dose using the appropriate diluent and by the correct route (DH [61], C; RPS [317], C).

   To protect the patient from harm (DH [61], C).
   If any of these pieces of information are missing, unclear or illegible, do not proceed with the administration. Consult with the prescriber.
   To prevent any errors occurring. E
3. 6.Show
   Take the medication and the prescription chart to the patient. Check the patient's identity by asking them to state their full name and date of birth. If the patient is unable to confirm these details, then check the patient identity band against the prescription chart. If an electronic identity check system for the patient and/or medicine identification is in place, then use it in accordance with hospital policy and procedures. Check the patient's allergy status by asking them or by checking the name band.
   To ensure that the medication is administered to the correct patient and prevent any errors related to drug allergies (NPSA [262], C).
4. 7.Show
   Remove the mouthpiece cover from the inhaler.
   To expose the area for use. E
5. 8.Show
   Shake the inhaler well for 2–5 seconds.
   To ensure mixing of medication in the canister (Potter and Perry [289], E).
6. 9.Show
   • Without a spacer device: ask the patient to take a deep breath and exhale completely, open their lips and place the inhaler mouthpiece in their mouth with the opening towards the back of the throat, then close their lips tightly around it.
   To prepare the airway to receive medication and direct the aerosol towards the airway (Potter and Perry [289], E).
   • With a spacer device: insert the metered dose inhaler (MDI) into the end of the spacer device. Ask the patient to exhale and then grasp the spacer mouthpiece with teeth and lips while holding inhaler.
   To enable the medication to reach the airways instead of hitting the back of the throat. The spacer improves delivery of correct dose of inhaled medication. E
7. 10.Show
   Ask the patient to tip their head back slightly then inhale slowly and deeply through their mouth while depressing the canister fully.
   To allow the medication to be distributed to the airways during inhalation. E
8. 11.Show
   Instruct the patient to breathe in slowly for 2–3 seconds and hold their breath for approximately 10 seconds, then remove the MDI from their mouth (if not using a spacer) before exhaling slowly through pursed lips.
   To enable the aerosol spray to reach the deep branches of the airways (Chernecky et al. [39], E).
9. 12.Show
   Instruct the patient to wait 20–30 seconds between inhalations (if same medication) or 2–5 minutes between inhalations (if different medication). Always administer bronchodilators before steroids.
   To ensure that the medication has the optimum effect and minimal side‐effects. E
10. 13.Show
    If steroid medication is administered, ask the patient to rinse their mouth with water approximately 2 minutes after inhaling the dose.
    To remove any medication residue from the oral cavity. Steroids may alter the normal flora of the oral mucosa and lead to development of fungal infection (Lilley et al. [174], E).

Post‐procedure

1. 14.Show
   Clean any equipment used and discard all disposable equipment in appropriate containers.
   To minimize the risk of infection (Fraise and Bradley [98], E).
2. 15.Show
   Record the administration on the appropriate charts.
   To maintain accurate records, provide a point of reference in the event of any queries and prevent any duplication of treatment (NPSA [267], C; RPS [317], C).