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Misunderstanding Medication Instructions
Healthcare practitioners sometimes take for granted that patients, including children, fully understand the instructions we provide about taking their medications. We assume that what seems obvious to us is also clear to patients. Unfortunately, patients often misunderstand the instructions, or our instructions set the patient up for a medication error.
A recent study appearing in the Journal of Asthma that evaluated MDI-spacer utilization and technique among 169 caregivers of Bronx minority children with persistent asthma showed some disheartening results.
Only 1 caregiver (0.6% of the total) correctly demonstrated all 10 steps on the MDI-spacer checklist, and 6 (3.6%) performed the 5 essential steps correctly. The most difficult steps for caregivers to successfully perform were having the child exhale before inhalation, having the child take at least 6 slow and deep breaths, and waiting at least 30 seconds before delivering the second puff of medication.
In a 2007 issue of CHEST, researchers reported that one in three patients with asthma or chronic obstructive pulmonary disease (COPD) misused their inhalers. In patients without previous instructions by a healthcare provider, the error rate was 52.6%; in patients who had been instructed, the error rate was 23.1%— meaning one in four patients with instructions still do not use their inhalers correctly.
The Institute for Safe Medication Practices has received similar reports showing a misunderstanding by patients on how to use inhalers. In one case, a newly diagnosed asthmatic patient was not responding to therapy. During a follow-up visit with his physician, the patient described how he was using his inhaler. He would get into his car, roll up the windows, release two puffs from his inhaler into the air, and breathe deeply for 15 minutes! At first, he did this in his house. Later he thought it might be more effective to use the inhaler in a confined space. He said he’d been instructed to do this by his doctor who picked up an inhaler, held it in the air, and released two puffs to demonstrate its use. The doctor gave no additional instructions.
Who teaches patients how to properly use any medication administered with an inhaler? Is there pharmacy involvement in education, particularly upon discharge from your organization? Have you witnessed similar misuse?
Matthew Grissinger, RPh, FISMP, FASCP, is the Director of Error Reporting Programs at the Institute for Safe Medication Practices.
