CHHS16/003

Canberra Hospital and Health ServicesClinical ProcedureAdult Nebulisation TherapyContents

Contents....................................................................................................................................1

Purpose.....................................................................................................................................2

Alerts.........................................................................................................................................2

Scope........................................................................................................................................ 2

Section 1 – Nebulisation Therapy Management.......................................................................3

Implementation........................................................................................................................ 4

Related Policies, Procedures, Guidelines and Legislation.........................................................4

References................................................................................................................................ 5

Search Terms............................................................................................................................ 5

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CHHS16/003

Purpose

To provide clinical staff with clear guidelines on the safe and effective management of an adult patient, receiving nebulisation therapy at Canberra Hospital Health Services (CHHS). CHHS Medication Handling policy (section 5.9.9) outlines when nebulisation therapy can be administered within the adult ward settings. Where possible an inhaler device with a spacer is the preferred method of administration, as this provides better medication uptake and should be used instead of nebuliser therapy.

Nebulisation Therapy is prescribed to: Administer medications Assist in the removal of accumulated bronchial secretions Liquefy bronchial secretions Relieve bronchospasm & dyspnoea

Alerts

Nebulisation therapy should be undertaken in a negative pressure room to prevent the spread of airborne infection to hospital staff and patients.

If a negative pressure room is unavailable, a single room should be used and the door kept closed. Place an “Airborne” precaution card in the Nobo® frame outside the room.

Patients with Chronic Obstructive Pulmonary Disease (COPD) should not receive nebulisation therapy using oxygen.

Nebulisation therapy is prescribed for a limited number of patients (e.g. upper airway obstruction and severe bronchospasm in the absence of pneumonia).

Where indicated, simultaneous oxygen maybe administered via nasal cannula. Specialist Medical Officer (SMO)/Visiting Medical Officer (VMO) input is required for any

patient who has an illness of sufficient severity to warrant nebuliser therapy. The use of nebulisation therapy is a SMO/ VMO level decision.

Scope

This clinical procedure applies to all ACT Health clinical staff who administer/manage nebuliser therapy for adult patients. They include: Specialist MO/ VMO Nurses and Midwives who are working within their scope of practice (Refer to Nursing

and Midwifery Continuing Competence Policy) Student Nurses under direct supervision.

The clinical procedure pertains to adult patients requiring nebuliser therapy at CHHS.

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Section 1 – Nebuliser Therapy Management

Equipment Alcohol based hand rub (ABHR) Medication as prescribed Ampoule sodium chloride 0.9% or sterile water Nebulisation mask, mouthpiece and tubing Oxygen tubing (optional) Nipple adaptor for air or oxygen outlet or air compressor Personal protective equipment (PPE) including safety goggles or shield, mask and clean

gloves High Filtration Mask (P2/N95) “Airborne” precaution warning card

Procedure Patient identification Single room is required for all nebulisation therapy and a negative pressure room is

recommended Check medication order and collect required medications and equipment Place an “Airborne” precaution card in the Nobo® frame outside the room Attend hand hygiene before touching the patient by either hand washing or using ABHR Explain the procedure to the patient Obtain consent Don high filtration mask for certain drugs only Don PPE Assist the patient to a sitting or semi-recumbent position Attend pre-medication peak flow measurement if indicated Document in the patients clinical records Twist nebule to open Place the open end of the nebule well into the nebuliser bowl and squeeze it slowly until

all the liquid has been emptied into the nebuliser bowl Add sodium chloride 0.9% or sterile water to make up a minimal volume of 4mL Reconnect the nebuliser Attach the tubing to the nebuliser, then to the air or oxygen outlet or air compressor If using an air pump, switch the power on For oxygen or air, adjust the flow rate (no less than 6L/minute and no more than 8L) to

achieve a fine mist Ensure the mask is properly fitted to the patient’s face Instruct the patient to breathe deeply and slowly If using a nebuliser with a mouthpiece, instruct the patient to close the lips firmly

around the mouthpiece and to inhale through their mouth and exhale through the nose Observe for any of the following side effects, report to the MO/VMO and the MO/VMO

will then decide if the nebulisation therapy should continue or be ceased. Document any of the below side effects:o Tachycardia/palpitations

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o Cyanosiso Flushingo Headacheso Fine muscle tremors (especially hands)o Vertigo

Wash the nebuliser with tap water and leave to air dry following each usage Attend post procedure peak flow measurement ten minutes after inhalation if indicated Attend hand hygiene after touching the patient by using either hand washing or ABHR Remove PPE Attend hand hygiene after by using either hand washing or ABHR Record nebuliser administration on the patient’s medication chart Document in the patient’s clinical record, the patient’s response to the procedure,

including pain/discomfort during and immediately after the nebuliser treatment. The Nebuliser set is classified as single patient use. They should be checked by staff and

if the patient is having the nebulisation therapy long term then infection control would recommend that they change the nebuliser and line once a week.

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Implementation

The use of nebuliser therapy is not new in CHHS but has restricted usage. Education and training to hospital staff will occur at ward level by the Clinical Development Nurse (CDN) and/or senior Nurses and Midwives.

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Related Policies, Procedures, Guidelines and Legislation

PoliciesCHHC Medication Handling Policyhttp://inhealth/PPR/Policy%20andPlans%20Register/Medication%20Safety.pdf Nursing and Midwifery Continuing Competence PolicyACT Health Waste Management Policy

ProceduresCanberra Hospital and Health Services- Healthcare Associated Infections 19/03/2015Nursing and Midwifery Continuing Competence SOPhttp://www.nursingmidwiferyboard.gov.au/Codes-and-Guidelines.aspx

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References

Asthma Management Handbook, 2014 http://www.nationalasthma.org.au/

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CHHS16/003

Centre for Disease Control and Prevention, 2004http://www.cdc.gov/ncidod/sars/

Esmond G, Update. Nebulisation Therapy, Professional Nurse, 1998; 14(1): 39

World Health Organization (WHO) Guidelines on Hand Hygiene in Healthcare, 2009.http://www.who.int/en/

5 moments of Hand Washing- Hand Hygiene Australia, 2015http://www.hha.org.au/

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Search Terms

Nebuliser, Therapy, Peak flow

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Disclaimer: This document has been developed by ACT Health, <Name of Division/ Branch/Unit> specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.

Date Amended Section Amended Approved ByEg: 17 August 2014 Section 1 ED/CHHSPC Chair

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Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register