MDI Inhaler Administration with Spacer

• Standard DOT procedure for administering metered dose inhalers (MDI) via a spacer with mouthpiece.
• The goal is to assist with safe and consistent inhaled medication administration.
• Maintain DIPPS throughout the procedure.

Supplies

• Medicated inhaler
• Spacer (aero chamber)
• Glass of water

Schedule

• See client specific instructions

Storage Space

• Options include cupboard beside or above fridge, cupboard beside or above kitchen sink, lock box, or other location.

Reportable Observations

• Inability to complete task
• Change in client condition
• Increased shortness of breath
• Client cannot breathe slowly enough through the spacer to prevent whistling sound

Procedure Steps and 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.
• Direct/assist client to sit in an upright position to allow client to breathe medication in as deeply as possible.
• Read the Client Specific Instructions.
• Start with the inhaler to ensure maximum effectiveness of medication.
• Check #1: Identify the Rights of Medication Assistance for safety to ensure client receives the correct medication.
• Remove the plastic cap off the inhaler mouthpiece and the spacer mouthpiece and check for foreign objects to ensure cleanliness and that there are no foreign objects present.
• Check #2: Identify the Rights of Medication Assistance for safety.
• Shake the inhaler vigorously at least ten (10) times to ensure medication is mixed.
• Check #3: Identify the Rights of Medication Assistance for safety.
• Put the inhaler mouthpiece into the large opening of the spacer (do not cover the small slots) to prepare for administration of medication through the spacer.
• Put the mouthpiece of the spacer into the client's mouth (between the client's teeth) and ask the client to close lips on the mouthpiece to position client to receive treatment, while ensuring the inhaler mouthpiece and canister are not held on an angle, as this may reduce the medication that reaches the client.
• Depress the metal canister into the inhaler to spray the medication into the spacer.
• Ask the client to take a slow, deep breath and to hold this breath for 5-10 seconds to be certain that client gets maximum dose of inhaled medication.
• The client can breathe in and out normally for 3 to 4 breaths after the deep breath.
• If a musical sound is heard, indicate the client needs to slow down the breathing, with a slow breath should last at least 5 seconds to allow the maximum amount of medication to enter in the lungs.
• If more than one puff of same medication is needed, wait at least 1 minute after the client's last breath from spacer to allow time for the medication to be absorbed into the client's respiratory system before administering a second dose, never spray more than one puff at a time into the spacer.
• For each puff of same medication needed, re-shake MDI (step 8) and repeat steps 10-14 to re-mix medication.
• Remove the inhaler from the spacer, replace inhaler cap and return inhaler to the storage area; ensures proper storage of medication.
• For each additional inhaler required, wait 5 minutes and then repeat steps 4-16 to ensure client receives the correct medication.
• After all required inhaled medications have been given, ask client to rinse mouth with water and spit water out to prevent mouth sores.
• Wash hands and return supplies to the storage area to maintain standard precautions and ensure proper storage of supplies.
• Sign flow sheet and report and record any reportable observations to maintain accurate records.

Step-by-step DOT procedure for administering metered dose inhalers (MDI) via a spacer with mouthpiece, ensuring safe and consistent inhaled medication administration. Includes supply gathering, assembly, and reportable observations. Maintain DIPPS throughout the procedure.