Now that staff are trained to assist residents with self-administration using a nebulizer, there are some questions to consider. Are your staff competent with assisting a resident with self-administration using a nebulizer? Are they making sure manufacturer guidelines and infection control guidelines are followed? Do they know the signs and symptoms to report to the physician or nurse when changes occur? Managing this will help keep your residents safe, your facility survey ready and possibly reduce hospitalizations for the residents.
A nebulizer is a drug delivery device used to administer medication in the form of a mist inhaled into the lungs. Nebulizers are commonly used for the treatment of asthma, COPD and other respiratory diseases. A nebulizer machine is a device comparable to an inhaler but is more suited for individuals with disabilities, elderly patients, or those with illnesses who find using their hands and taking deep inhalations to be strenuous. Nebulizers create an aerosol that releases medication directly into the lungs without needing specialized breathing techniques. Many medications are available for inhalation treatments which are delivered directly into the resident’s airway.
So, what steps should you take when assisting a resident with self-administration of medications using a nebulizer? First, make sure to follow the current order with the “nine rights:” right patient, right medication, right dose, right time, right route, right documentation, right response, right reason, and right to refuse.
Then to assist your resident, follow these steps:
- Place the air compressor unit on a surface, where it can safety reach its power source and be easily turned on / off.
- Wash hands and obtain necessary items (prescribed unit dose medication with label, MOR, gloves. Check expiration date of the medication.
- Triple check the medication label with the medication observation record (MOR). Check the MOR, then the medication label, then the MOR before providing the medication to the resident.
- Follow the facility policy for identifying the resident. Address the resident by name and ensure resident privacy.
- Explain the procedure. Read the medication label to the resident and confirm understanding. Ask the resident to sit up upright when possible. Wash hands again. Put on gloves.
- Always use a clean nebulizer delivery system for each use.
- Open the prescribed, unit dose prefilled vial/container of medication solution and pour the solution into the nebulizer jar and tighten the lid.
- Connect the air tubing from the air compressor unit to the nebulizer jar. Make sure all connections are tight and secure.
- Attach the face mask/mouthpiece to the nebulizer unit.
- Turn the air compressor on and observe the nebulizer for misting.
- Hand the nebulizer mask to the resident and assist the resident with placing on his/her face, making sure that the nose and mouth are covered. The mask may be secured to the resident’s head with the elastic band. If a mouthpiece is being used, instruct the resident to place the mouthpiece between the teeth and close lips around mouthpiece.
- The resident’s head should remain upright and maintain the nebulizer jar upright. This will allow for proper administration of the medication.
- Instruct the resident to take slow normal breaths throughout the treatment. This will allow the medication to settle in the resident’s airways.
- Instruct the resident to occasionally tap the outside of the nebulizer jar; this helps with the utilization of all medication.
- Inform the resident to continue with the treatment until an onset of sputtering sound or inconsistent nebulization coming from the nebulizer. The jar will have just a little medication left inside.
- Record assistance with self-administration on MOR. Document any refusal or other reason medication was not administered as ordered.
- Remove and dispose of gloves.
- Wash hands thoroughly.
- Monitor for side effects or adverse effects. If dizziness or jitteriness occurs, stop the treatment and have the resident rest for about 5 minutes. Continue the treatment and instruct the resident to breathe more slowly. If dizziness or jitteriness continues to be a problem, inform the health care provider/doctor and obtain further instruction.
After the resident has been assisted to receive the medication with the nebulizer and all steps have been completed, it is important to follow the manufacturer’s instruction for cleaning the nebulizer unit and filter. After each treatment, rinse the nebulizer cup thoroughly with warm water, shake off excess water, and let air dry. It is not necessary to clean the compressor tubing and allow the nebulizer equipment to completely dry before storing in a plastic, zippered bag. Be sure to replace the tubing and mask according to the manufacturer’s instructions. Following your facility’s infection control policy is critical for safe assistance for the resident and staff. Routine cleaning of these devices is a must.
What should the staff report to the physician or the nurse to relay to the physician concerning a resident who receives medications via a nebulizer? Since residents who receive medication via a nebulizer for a respiratory condition, any symptom that is increased or a change related to the respirations should be reported to the physician and or home health nurse. Symptoms such as:
- The resident has an increased cough and/or sputum.
- The resident has increase in shortness of breath with his or her usual activity level.
- The resident has an increased the amount of quick relief medications used.
- The resident has had a change in their usual energy level – increase in either tiredness or restlessness.
- The resident needs more pillows to sleep.
- The resident has more swelling in his or her ankles more often than usual.
If the resident has symptoms such as very short of breath, trouble walking and talking due to shortness of breath, or skin color is pale or gray, or cannot do usual activities, make sure staff calls 911 for emergency care. Waiting to speak to the home health nurse or physician will not help when these symptoms happen.
The expanded skills that a trained, unlicensed staff member can assist with has brought positive help for residents who routinely or intermittently need medications via a nebulizer. But, with that comes added responsibility and possible problems. Make training with this skill a frequent purposeful task to help you provide safe assistance and ensure proper infection control with nebulizers in assisted living facilities.