P187 Ease of use, effectiveness and environmental impacts: Evaluating inhaler prescriptions, patient preferences and opportunities for improvement

Improving respiratory care is good for patients and good for the planet. Inhalers contribute 4% of the NHS’s carbon footprint. The NHS committed to 51% carbon emissions reduction by 2025 (on 2007 baseline). The carbon footprint of dry powdered inhalers (DPIs) is 8gCO2eq/dose. Metered dose inhalers (MDIs) have 10 times this footprint (82–119gCO2e/dose).MethodsWe designed scoring systems to assess DPI and MDI technique (image). We developed a survey to assess patients’ inhaler prescriptions, technique and preferences. We piloted and amended the survey twice to improve coherence and clarity; then surveyed twenty respiratory ward inpatients over six weeks.Results20/20 patients were prescribed both MDI and DPI, but some did not have both inhalers at their bedside.DPI16/20 had a DPI at the bedside. 14/16 felt very confident or confident using the DPI, 2/16 somewhat or not confident. 13/16 remembered being shown how to use their DPI.Checking DPI technique, out of 5 points: 8/16 scored 5, 3/16 scored 4, 3/16 scored 3, 2/16 scored 2.MDI17/20 had an MDI at the bedside. 13/17 felt very confident or confident using the MDI, 4/17 somewhat or not confident. 15/17 rememberd being shown how to use their MDI.Checking MDI technique, out of 4 points: 5/17 scored 4, 4/17 scored 3, 8/17 scored 2. 9/17 patients lost a point due to not using a spacer. 9/17 patients said they use a spacer. 4/9 find cleaning a spacer inconvenient. 3/9 find carrying a spacer inconvenient.Recycling11/17 said they know when their MDI needs replacing. 6/17 automatically receive an MDI on every prescription. 5/16 automatically receive a DPI on every prescription.4/20 knew that they could return inhalers to pharmacies for recycling. 6/20 knew that inhalers should not be put in council recycling bins.Preferences16/20 would be willing to change inhaler for one that is easier to use. 20/20 would change for increased effectiveness. 16/20 would change for lower carbon footprint.Abstract P187 Figure 1Scoring system used to assess response to the question ‘Please demonstrate your inhaler technique’. One point is given per item correctly demonstrated DPI – Out of FIVE Demonstrated correctly Not demonstrated correctly 1. Prime the inhaler 2. Empty lungs 3. Positioning(sat up straight, head up) 4. Mouth seal and deep inhalation 5. Hold breath 10 seconds (or as close as possible) MDI – Out of FOUR Demonstrated correctly Not demonstrated correctly 1. Attach spacer 2. Empty lungs 3. Positioning(sat up straight, head