Nurses' Reports of Inhaler Use Errors in Patients with Chronic Obstructive Pulmonary Disease in Hong Kong

Background: Persistently high rates of inhaler errors and poor adherence among Chronic Obstructive Pulmonary Disease (COPD) patients contribute to ineffective symptomatic control, high care burdens, and increased healthcare resource utilization.

Objective: This study aimed to report (i) nurses-identified common problems and errors of inhaler use in COPD patients, (ii) nurses' attitudes, practices, training needs and required support in inhaler education.

Methods: An online questionnaire survey was conducted with nurses working in Hong Kong from May to June 2023 using an exponential, non-discriminative snowball sampling strategy.

Results: Of 156 nurses (67.3% female, 41% aged 40 or above), 37.2% and 62.8% of them had more than 10 years of experience in medical units and received respiratory-related specialist training, respectively. About 86% and 82% perceived that their patients did not have adequate basic knowledge and had incorrect use of their inhaled medications. High rates of inhaler use errors were observed by nurses across all phases: preparation (50%-92%), pre-inhalation (45%-89%), inhalation (69%-89%), and aftercare (66%-85%). Nurses with ≥10 years of working experience in medical units or specialist training showed significantly more confidence in educating on inhaler use, engaging in more discussion with patients about inhaler use, and assessing patient inhaler use techniques more frequently than those with less experience or no respiratory-related specialist training with small effect size (Cohens'd: 0.26-0.33).

Conclusion: Inhaler use errors were common issues among COPD patients in Hong Kong. Enhanced professional training and support in inhaler education could improve nurses' confidence and practices in conducting patient education on inhaler use.