METERED-DOSE INHALERS - DO EMERGENCY HEALTH-CARE PROVIDERS KNOW WHAT TO TEACH

Study objective: To evaluate the ability of emergency health care prov iders and patients to demonstrate the proper use of metered-dose inhal ers (MDls). Design: Prospective cross-sectional survey. Setting: Five Midwestern community teaching hospitals. Participants: One hundred eig hty-five health care providers, comprising emergency medicine house st aff (n=60), attending emergency physicians (n=50), and ED nurses (n=75 ). Also recruited were 100 consecutive ED patients with clinical histo ry of asthma being treated with at least one MDI for more than 3 month s. Interventions: We surveyed patients and health care providers to as sess their knowledge of and ability to use a conventional MDI. The sub ject's technique of using a placebo inhaler was graded by a trained ob server using a checklist of six essential steps. Results: Forty-one pe rcent (76 of 185) of health care providers and 49% (49 of 100) of ED a sthma patients performed at least five steps correctly (P=.24). There were no significant differences in performance scores among the emerge ncy medicine house staff (42%), attending emergency physicians (34%), and ED nurses (45%). Only 15% of all health care providers and 17% of asthma patients were able to describe how to estimate the amount of me dicine left in the canister. Conclusion: These results suggest that ma ny patients use MDls improperly. Emergency physicians, house staff, an d nurses responsible for instructing patients in optimal inhaler use m ay lack even rudimentary skills with these devices.