321 Improvement of Nasal Spray Technique in Patients in an ENT Outpatient Clinic: A Quality Improvement Project

Background anagement of allergic rhinitis involves administration of intranasal corticosteroid sprays and efficacy relies on correct technique. Treatment failures result in poor disease control, non-compliance, increased ENT appointments and unnecessary surgeries. The correct technique involves applying the spray to the turbinates (side wall), to reduce inflammation that leads to obstructive symptoms. Aim To improve Nasal spray technique amongst patients in an ENT outpatient clinic, using a patient education tool. Method PDSA 1: Designed a survey to assess current technique and identify areas for improvement. PDSA 2: First cycle identified 4 key steps for improvement. A leaflet was designed highlighting these steps and handed out to patients who were prescribed the spray. Patients were called 2 weeks later to assess technique. PDSA 3: Leaflet and teach-back method was used to demonstrate correct technique and patients were called back in 2 weeks. Results PDSA 1: Only 2% (1/53) of patients used spray correctly and 86.8% of patients administered the spray in the centre of the nose. PDSA 2: 60% (7/11) of patients used spray correctly. PDSA 3- 100% (6/6) of patients used correct technique. Aim of spray to the side of nose was only 5.7% in PDSA 1 which increased to 100% in PDSA 3. Conclusions This QIP identified poor nasal spray technique amongst 98% of ENT patients, which may cause treatment failure. Introducing simple and cost-effective interventions, increased the number of people using the spray correctly. These interventions could easily be implemented in ENT and GP clinics, to improve technique reducing repeat appointments and unnecessary referrals.