B38-06 Assessing Teaching Consistency of Optimal Technique With Metered-dose Inhalers at Niswonger Children’s Hospital

Abstract Rationale Incorrect metered-dose inhaler (MDIs) use persistently contributes to poor asthma control in pediatric patients. Hospital personnel are often responsible for providing discharge instruction on MDI use, yet their techniques and instructional consistency vary. Evidence suggests that this inconsistent teaching leads to worse outcomes. Asthma is a significant contributor to pediatric morbidity in Appalachia, underscoring the importance of optimizing discharge teaching at Niswonger Children’s Hospital. This study aims to assess the consistency and accuracy of hospital MDI instruction, whether confidence or experience is a factor in quality, and areas of improvement to address in future projects. Methods We designed a cross-sectional quality improvement project at Niswonger Children’s Hospital. Clinical personnel including nurses, respiratory therapists, residents, and attendings demonstrated their MDI technique with a spacer. A standardized checklist based on national inhaler guidelines and the World Health Organization’s guidelines was used to evaluate steps such as device priming, exhalation before inhalation, coordination of actuation and inhalation, breath-holding, and repetition. Participants reported their confidence in teaching this technique, years of experience, and resources they felt would improve their technique. Participant accuracy was calculated from responses, and each group’s accuracy was determined. ANOVA single factor and t-test two-sample assuming equal variances tests were utilized to determine the significance in correct technique variance among groups. Results Attendings had an average correctness of 50.9% with respiratory therapists, residents, and nurses measuring 47.5%, 37.5%, and 30.2%. Attendings displayed a negative correlation between correctness and both confidence and experience. The steps with significant variability between groups were shaking the inhaler well, placing the mouthpiece correctly, and taking a slow deep breath. Conclusion The results revealed significant gaps in skill across professions and experience levels. The number of steps correctly performed was highest amongst attending physicians, but all groups scored significantly less than expected. In Niswonger Children’s Hospital, it was reported that the majority of MDI technique education is performed by respiratory therapists, but many other staff members may contribute to this education. This points to a critical need for re-evaluation and standardization of teaching methods for healthcare professionals, to ensure that patients receive consistent, clear instructions for MDI use. Additional resources proposed by Niswonger staff are a standardized video for patients to watch and the necessary medical equipment present at discharge for hands-on practice. In the future, we hope to find that improvements in patient education will promote increased adherence to treatment and better asthma symptoms. This abstract is funded by: None