Metered Dose Inhaler (MDI) via Spacer

• Standard DOT Procedure details administration of metered dose inhalers (MDI) via a spacer with mouthpiece

Goal

• Assist with safe and consistent inhaled medication administration
• Maintain DIPPS throughout procedure

Supplies

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

Schedule

• Consult client-specific instructions

Storage Space

• Cupboard beside or above fridge
• Cupboard beside or above kitchen sink
• Lock box
• Other

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 and Rationale

• Wash hands: Maintain cleanliness as per standard precautions
• Gather supplies and assemble on a clean, dry surface: Complete task in an organized manner
• Direct or assist client to sit in an upright position: Allow client to breathe medication in as deeply as possible
• Read the Client Specific Instructions; Start with the inhaler: Ensure maximum effectiveness of medication
• Check #1 Identify the Rights of Medication Assistance: Ensure client receives the correct medication
• Remove plastic cap off inhaler and spacer mouthpiece; check for foreign objects and ensure all parts are secure: 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: Ensure medication is mixed
• Check #3 Identify the Rights of Medication Assistance: For safety
• Put inhaler mouthpiece into the large opening of the spacer; do not cover the small slots: 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; make sure that the inhaler mouthpiece and canister are not held on an angle: Position client to receive treatment.
• Depress the metal canister into the inhaler: Spray the medication into the spacer
• Ask the client to take a slow, deep breath and hold this breath for 5-10 seconds: Be certain that client gets maximum dose of inhaled medication.
• Ask the client to breathe in and out normally for 3 to 4 breaths.
• If you hear a musical sound, ask the client to slow down the breathing; a slow breath should last at least 5 seconds: Allow the maximum amount of medication to enter 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; do not spray more than one puff at a time into the spacer: Allow time for the medication to be absorbed into the client's respiratory system before administering a second dose.
• For each puff of same medication needed, re-shake MDI (step 8) and repeat steps 10-14: 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: 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: Prevent mouth sores.
• Wash hands; Return supplies to the storage area: Maintain standard precautions; to ensure proper storage of supplies.
• Sign flow sheet; Report and record any reportable observations: Maintain accurate records.

Standard procedure for administering metered dose inhalers (MDI) using a spacer with a mouthpiece. This lesson outlines the necessary supplies, step-by-step instructions, and reportable observations to ensure safe and effective medication delivery. This also covers the importance of maintaining client safety and hygiene throughout the procedure.