Hospital staff practical skills and theoretical knowledge in inhaled aerosol therapy: a single centre cross-sectional observational study

Abstract

Inhaled therapy is widely used for treatment of many respiratory disorders. Drug delivery in lungs is dependent on the correct use of aerosol devices and patients’ training is vital for a correct therapy administration. Therefore, is very important to assess the skills of professionals involved in training patients to the correct use of inhaler devices. The aim of this study was to check the practical skills and the theoretical knowledge of health care personnel in our University Hospital in using aerosol therapy and to determine differences among professional figures in the management of inhaler devices. Three hundred and fifteen (315) volunteers including physicians, residents, nurses and respiratory physiotherapists were enrolled; an independent professional, not working in our University Hospital, assessed their theoretical knowledge related to aerosol throughout a questionnaire. Practical skills were assessed through placebo simulation with the devices that participants declared to use frequently with patients. None of the respondents correctly answered all questions evaluating theoretical knowledge on the proper use of aerosol therapy. Respiratory physiotherapists obtained significantly better results with 17.2 (1.3) average points compared to 10.3 (3.7) obtained by doctors, 9.0 (3.0) by nurses and 9.1 (4.5) by residents. Analysing in detail physicians’ results, pneumologists showed better theoretical knowledge than other specialists. Concerning the practical skills, about 80% of those stating they knew how to use metered dose inhalers, made mistakes in the basic steps for proper inhalation technique and over 50% of respondents were unable to properly simulate placebo administration of dry powder inhalers. Also here, respiratory physiotherapists and pneumologists had significant better performances, when compared to other health professionals. Our data are in line with those published in the literature in other international clinical settings, noting inadequate practical and theoretical knowledge of the available devices for aerosol therapy.

Inhaler technique in a pediatric emergency department: Impact of an education intervention among healthcare professionals

“…At baseline, we obtained global poor results in theoretical and practical skills. In line with our findings, Santambrogio et al 6 found that the medium score in the evaluation of IT was 9.9 over a total score of 21 and that none of the participants answered correctly to all the theoretical questions. Similarly, Spaggiari et al 11 conducted a study in the PED, detecting that only 49% of participants did all the steps correctly in the practical examination and 34% almost perfectly.…”

“…On the other hand, the most forgotten step in IT with spacer and mouthpiece was taking a deep exhalation before inhalation (75%) followed by exhaling slowly after inhalation (79.8%). Similar results were obtained in a systematic review by Plaza et al 10 However, in other studies, the most frequent errors were not breath‐holding after inhalation and not waiting a minute before the next inhalation 6 . These results are especially important, as identifying gaps in knowledge regarding proper IT is essential to impart continued education programs.…”

“…This can be explained by the fact that, in our hospital, MIR follow a specific program in which they are trained in IT, hence, having better scores despite being younger and having fewer years of experience. Previous studies did not find differences between age or years of experience either 6 . With respect to practical skills, MIR obtained better results than nurses.…”

“…In contrast, previous studies observed that nurses obtain higher scores than physicians. This finding has been attributed to scarce specific education to medical doctors on this subject due to the fact that nurses are the ones who usually conduct and teach IT 5,6,12 . Additionally, we obtained that participants with history of asthma obtained higher scores in IT with spacer and mouthpiece, as this technique is similar to IT in adults.…”

“…Performing inhaler technique (IT) correctly is a simple but effective method to improve asthma control in children 2–4 . However, many reports have shown that the majority of the healthcare providers involved in caring for patients with respiratory diseases, including doctors and nurses, have poor knowledge of IT 5–7 …”