Take The Metered-Dose Inhaler (MDI)
Checklist Challenge
Incorporate this checklist in your training efforts
and watch for positive changes in patient outcomes.1
•U
se this checklist to ensure the proper use of the metered-dose inhaler
(MDI) at each appointment
• Have the patient or caregiver demonstrate using the MDI against the
checklist of steps below
• Score 1 point for each step performed correctly
• If errors are made, demonstrate the correct way to complete the step;
ask the patient or caregiver to repeat the step to make sure they
understand the correction
• Repeat until all steps are correct
mistakes
r these common
2
Look out fo
l
✓ F ailing to shake ingehantlelyr wbeelfore inhaling
✓ F ailing to exhale ordination (failing to press down
✓ E xhthibeiticangniposterorancod inhale simultaneously)
on
slow)
n should be very
tio
la
ha
(in
y
dl
pi
ra
✓ Inhaling
all
or not inhaling at
ly,
ep
de
le
ha
in
✓ F ailing to
enough
one’s breath long
ld
ho
to
g
lin
ai
F
✓ 0 seconds is optimal) or at all
(1
s) before
ough (≥30 second
en
ng
lo
t
ai
w
to
✓ F aielinnegxt puff
th
es in a row
e canister 2 or 3 tim
th
on
n
w
do
g
in
✓ P reisssshould be done only once)
(th
cts,
e for foreign obje
ec
pi
th
ou
m
e
th
t
✓ F aichlingastocoininsps ec
su
tuator
dically clean the ac
rio
pe
to
g
in
tt
ge
or
✓ F
e
wn (the mouthpiec
do
de
si
up
ce
vi
✓ H oloudildngbetheondethe bottom)
sh
wn
while pressing do
on
p
ca
e
th
ng
vi
ea
✓ L
inhalation
te activation with
na
di
or
co
to
g
lin
ai
RRT,
✓ F
Dean Hess, PhD,
on errors cited by
es of comm
le.2
These are exampl
r errors are possib
he
ot
;
ol
ho
Sc
al
ic
of Harvard Med
Check off each step that the patient
and/or caregiver completes correctly3
Name of patient/caregiver ____________________________________
Name of inhaler ________________________________________________
❑ Removes all packaging from inhaler, including foil (if applicable)
❑ Inserts metal canister into plastic holding device
❑ Removes mouthpiece cover
❑ Keeps canister in a vertical position
❑ P
rimes inhaler (if needed) according to package insert
❑ Checks for foreign objects in mouthpiece
❑ Shakes inhaler thoroughly (10 to 30 seconds)
❑ Holds head upright
❑ Takes deep breath in
❑ Exhales fully before next breath
❑ U
ses either 2-finger method or holds inhaler in mouth (2-finger method:
holds inhaler 2-fingers’ length away from mouth)
❑ Inhales and presses canister to release medication at the same time
in coordinated motion
❑ H
olds breath for 10 seconds after inhalation
❑ Lets breath out
❑ R
inses mouth with water after last puff of medicine, spits out water,
and does not swallow it
❑ R
eplace the mouthpiece cover on the MDI after each use
❑ R
emoves metal canister to clean holding device
❑ W
aits 60 seconds before inhaling a second puff (if applicable)
Total score: ________ MDI use evaluated by: ______________________________
References: 1. National Asthma Council Australia. Inhaler Technique in Adults With Asthma or COPD. South Melbourne, Australia: National Asthma Council
Australia Ltd.; 2008. 2. Hess DR. Aerosol delivery devices in the treatment of asthma. Respir Care. 2008;53(6):699-723. 3. Elliott D. Guide to Aerosol Delivery
Devices for Physicians, Nurses, Pharmacists, and Other Health Care Professionals. Irving, TX: American Association of Respiratory Care; 2011.
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