Directly Observed Therapy (DOT) with Diskus

• The purpose of the DOT (Directly Observed Therapy) procedure is to assist with safe and consistent inhaled medication administration via Diskus.
• Diskus medicated inhaler and a glass of water are needed.
• Client-specific instructions are required for schedule.
• The Diskus must be kept dry at all times.

Reportable Concerns

• Inability to complete task.
• Change in client condition.
• Client or family member requesting change in the DOT procedure.
• Increased shortness of breath.
• Diskus damaged.
• Diskus has been wet.

Storage Space

• Cupboard
• Med-lock box (if required)
• Other

Procedure & Rationale

• Wash hands to maintain cleanliness as per standard precautions.
• Gather supplies and assemble on a clean, dry surface to complete task in an organized manner.
• Check #1 Identify the Rights of Medication Assistance to ensure the correct medication is given as ordered.
• If the dose counter reads 'O', start a new Diskus, remove from box and remove the foil over-wrap pouch to ensure medication is used within a safe time period.
• Write the "pouch opened" and "use by" dates on the Diskus label; the "use by" date is one month from date of opening.
• If a new Diskus is started, repeat step 3 to ensure medication is correct and available.
• Open the Diskus by holding it in one hand and pushing your thumb away as far as it will go until the mouthpiece appears and snaps into position to access the mouthpiece and medication inside.
• Check #2 -Identify the Rights of Medication Assistance to ensure the correct medication is given as ordered.
• Tell the client to breathe out as far as is comfortable and place the mouthpiece of the Diskus to lips to help the client understand how to use the Diskus correctly.
• Ask the client to breathe in quickly and deeply through the Diskus, not through the nose, then remove the Diskus.
• Instruct the client to hold breath for 10 seconds, then breathe out slowly, and not to breathe out through the Diskus.
• Check #3 Identify the Rights of Medication Assistance to ensure the correct medication is given as ordered.
• Check dose counter for number of doses remaining, and document this number to ensure there is medication available.
• Once the Diskus is loaded, it must be kept in a flat, level, horizontal position, and must not be shaken.
• Load the Diskus by holding in a flat, level, horizontal position with the dose counter facing up.
• Slide the lever away from the mouthpiece towards the dose counter as far as it will go; listen for a click indicating the Diskus is now loaded, to prepare a dose of medication for inhaling.
• Look at the dose counter to ensure that it reads one number less than prior to loading to ensure a dose of medication is loaded.
• If the does number has not gone down by one, note the number on the does counter and repeat steps 11 and 12.
• Ask the client to breathe out as far as possible to prepare client to receive medication.
• Put the mouthpiece of the Diskus to the client's lips to prepare client to receive medication.
• Ask the client to breathe in quickly and deeply through the Diskus, not through the nose to ensure the client receives the full dose of medication, and to keep the Diskus dry.
• Remind the client to hold his/her breath for 10 seconds, or as long as is comfortable, then to breathe out slowly.
• Close the Diskus by putting your thumb on the thumb grip and sliding it towards the mouthpiece as far as it will go until the Diskus clicks shut to reset the Diskus and make ready for the next dose.
• Instruct the client to rinse his/her mouth with water and spit water out to prevent mouth sores.
• Return the Diskus to the storage space to ensure safe storage of medication.
• Sign MAR/flow sheet and report and record any reportable concerns to maintain accurate records.

This lesson outlines the Directly Observed Therapy (DOT) procedure for safe Diskus inhaler administration. It covers necessary supplies, reportable concerns such as increased shortness of breath, proper storage, and step-by-step instructions. The importance of hygiene and medication rights are also emphasized.