Abstract:
Background: Inhaler technique is an important component of effective asthma management, with national recommendations supporting regular assessment and review. However, assessment may not be possible when patients do not bring their inhaler and spacer to clinic. This quality improvement project aimed to improve inhaler availability for assessment and increase the proportion of patients receiving inhaler technique review in a paediatric respiratory clinic.
Methods: A baseline audit was undertaken among randomly selected patients attending a paediatric asthma clinic over a 4-week period. Three months later, the audit was repeated over a similar period following implementation of an additional SMS reminder intervention. Patients continued to receive the standard clinic appointment letter. In addition, parents/carers received an SMS reminder the day before the appointment confirming the date and time and specifically reminding them to bring the patient’s inhaler and spacer to clinic.
Results: At baseline, 7/23 patients (30.4%) brought their inhaler to clinic and 6/23 (26.1%) received an inhaler technique review. Following introduction of the SMS intervention, 10/16 patients (62.5%) brought their inhaler to clinic, representing a 32 percentage-point increase. The proportion receiving documented inhaler technique assessment increased to 10/16 (62.5%), a 36 percentage-point increase. The SMS intervention was delivered to all patients in the re-audit cohort (16/16, 100%). Among patients assessed, the proportion requiring correction of inhaler technique increased from 2/6 (33%) to 4/10 (40%). The increased number of assessments also identified equipment-related problems, including cracked or inappropriate spacers and device leaks, alongside technique errors such as failure to shake the inhaler and incorrect cleaning.
Conclusion: Addition of a simple SMS reminder to the existing clinic appointment letter increased the proportion of patients bringing their inhaler to clinic from 30.4% to 62.5% and enabled a corresponding increase in documented inhaler technique assessment. The intervention improved the reliability of the assessment process and identified previously unrecognised technique and equipment-related problems. Further quality improvement cycles will focus on standardising inhaler technique assessment and education and addressing equipment-related barriers.
