Accuracy of inhaler and nebulizer prescribing in hospitalized patients

Introduction: There are a considerable variety of inhaler devices available. It is important that these are prescribed correctly when a patient is admitted to hospital as incorrect prescribing may have an adverse effect on patient recovery and length of stay. We have investigated the accuracy of inhaler prescribing on the respiratory wards in our hospital. Methods: All admissions into the respiratory wards (total no of beds =57) between March to May 2010 were included (total 83). All case notes were retrieved and only patients on inhalers or nebulizers were included. Results: 83 patients were admitted of whom 44 (53% of total, age range 20-92, 68% female) were on inhalers or nebulizers prior to admission. COPD (57%) was the main reason patients were on inhalers/nebulizers. Table 1. Indications for inhaler/nebuliser prescribing COPD 24 (54.5%) Asthma 7 (15.9%) Asthma/COPD 1 (2.3%) Cystic fibrosis 5 (11.4%) Bronchiectasis 3 (6.8%) Asthma/Bronchiectasis 4 (9.1%) Detailed accuracy of prescribing on admission during this period is detailed in Table 2. Table 2. Inhalers/nebulisers prescribed on drug chart SABA inh SABA nebs Steroid inh LAMA inh SAMA inh SAMA nebs Combined LABA/Steroid Home use 30 (68.1%) 14 (31.8%) 6 (13.6%) 17 (38.6%) 1 (2.3%) 2 (4.5%) 27(61%) Prescribed in hospital 16 (53.3%) 25 (179%) 4 (66.7%) 11 (64.7%) 0 (0%) 16 (800%) 25(92.6%)[4 new prescriptions] Correct dose prescribed 4 (13.3%) 12 (85.7%) 3 (50%) 10 (58.8%) 0 (0%) 2 (100%) 17(63.0%) Correct device prescribed 2 (6.7%) NA 0 (0%) 2 (11.8%) 0 (0%) NA 5(18.5%) Conclusion: Our results show that inhaler prescribing in hospitalized patients is poor and hospital doctors need to prescribe the correct medication for the patient as a duty of care during their in-patient stay.