inhalers

[Truegem]

What do you all do with your plastic inhaler canister holders when you give a one time dose to an inmate?

We were cleaning them in a bleach solution and reusing them. Suddenly we are changing this. We will now throw the plastic part away and send the inhaler (the metal part that holds the medicine) back to the Pharmacy. The manufacturer will not sell the plastic holders, so basically the inhaler is useless. So we are essentially throwing away the entire inhaler after one use. Personally I think it is ridiculous overkill. Bleach kills germs. They are probably cleaner than when they came out of the brand new box after cleaning them with bleach! Keep in mind that when you go to a restaurant, the dishes that you are eating off of were used by another person and were only cleaned in soap and water. Not even bleach!

I feel that this is germ-phobic overkill. The cost to the taxpayers is unnecessary. Did you guys know that they clean colonoscopy equipment in a bleach-like solution and then use them again on another patient??? Something that was in someone else's rear-end! And this is an accepted practice. But we are choosing to throw away inhalers because someone else put their mouth on it once, for a second, and bleach isn't good enough. The mouth is a clean area, not sterile. We learned that in nursing school. What do you guys think? And please tell me what you do when you give a one time dose to a patient.

[RN Randy]

Um... what knucklehead thinks that a one-time treatment with an inhaler is the best plan of care anyway?

For a single treatment, acute care should be with a disposable hand-held nebulizer. When the acute condition ends, toss the neb.

Only when and if the condition becomes chronic, would you switch to the MDI, after proper training and return demonstration of ability.

The thing to remember is that not all pt's have the inspiratory capacity or coordination ability to properly use an MDI. If grandpa's vital capacity is only 500ml, then 3/4 of the medication deposition will be in the pulmonary deadspace and do zero good.

Shove an inhaler in someone's mouth once a year and they will either inhale too quick, not hold their breath at max inspiration, or whatever, causing high particle deposition in the oropharynx, and/or little to no deposition in the parenchyma, and probably exhale the rest.

But to climb down off my soapbox and get to the point...

Read the side of the box. It says Single Patient Use.

Reuse of disposables is a big fat no-no.

You are throwing them away because they are used by said single patient.

MDI's are not for single treatment use. Period.

Your mid-levels or phys needs to start ordering nebs for single treatments.

Also, from the scientific point of view, continuted use and cleaning of a disposable item will degrade the plastic and nozzle thus increasing medication particle size outside specs and also affect deposition in the airway. Again, a useless practice.

Either way, it's a lose/lose situation from a legal standpoint, and a proper patient care standpoint.

However;

[NurseLite]

Who orders MDI's for single use?

[RN Randy]

Yeah, exactly... LOL. I just re-read that and realized that someone in that facility apparently figured out that reuse of the single-use disposable is wrong, [JCAHO is doing rounds about now...] but instead of using nebs as would be expected, they are still going to order one-time MDI's, toss the plastic, shoot the canister to the pharmacy which will return it to the supplier for credit, [so the prison appears to save money] and drive up costs even more...

talk about bilking the taxpayers!

MDI's are only cheaper for chronic use in the long run, and I've never seen anyone order one for a single dose either.

Gem, is that some standing protocol, or is somebody actually ordering that?

Perplexed.... ??

rb

[Truegem]

Ok, let me explain. I'm not talking about a newly diagnosed patient who can't breathe! (Um, I never said that, lol) These are people who have an inhaler assigned to them (although they are not allowed to carry them). They have chronic asthma. They use an inhaler PRN. The nurses bring it to them QID as needed. When they are away from where their inhaler is kept (going to court, being rehoused, etc) and they need a couple puffs (routine, not acute) we will grab a new one and give them a couple puffs. So, after that one time use, we are tossing the inhaler. We could simply clean the mouthpiece and have it ready for another one-time use, like we'd been doing for years. Mind you, they are cleaned in bleach or Cidex. They are cleaner than when they came out of the box! And I just feel that throwing the inhalers away after one time use, rather than continuing what we're doing, is overkill and germ-phobic. Once again, they clean colonoscopy equipment in Cidex and use it on another patient. And once again, restaurants don't give you brand new dishes after someone eats on them. They do what we call cleaning. I am against throwing the entire inhaler away at the expense of the taxpayers. We probably use 5 to 10 for a one time use each day. At $30 to $40 each that is $180 to $400 a DAY! Ridiculous!

(No, we do not treat an acute asthma attack with a simple couple puffs of albuterol. We use nebulizers, prednisone, etc. I'm talking about routine use.)

-Gem =)

[Truegem]

Ok, I just read the part about the plastic degrading. I suppose that makes sense, but is there data to support this? What about the colonoscopy equipment being sanitized and reused? This is a common practice (not in our facility, it's done everywhere.)

You have to admit the germ argument is silly if you know anything about bleach and the mouth being a clean area, etc.

So that is what bothers me about it.

What do other jails do in this sutuation? Are most facilities allowing self-carry? What about those facilities that do not allow them to carry their inhalers?

[aknurs]

In my facility MDI's are allowed KOP (Keep on Person), unless they abuse them. In the case of abuse, they are keep on the medcart,(the inmates name & Rx is on the box) the inmates can have their dose at medline times.

If they still abuse them, by taking more than the Rx amount of puffs, they are to put their mouth near the tray slot & the medication is administerd by the nurse. (The last senerio rarely happens, but it has been done.)We don't do one time MDI..The only thing we do one time is the Nebulizer Tx.'s , then after the tubing/pipe is used, it is thrown away.

[RN Randy]

Understand... however; I still have to refer back to 'single use disposable'.

As for dishes and 'scopes, they are not manufactured with disposablilty in mind, and are made of different polymers suited for multiple use.

It isn't about germs at all.

Cidex has lived it's useful life and won't be much trouble in one's butt on a scope, but when you consider that cidex in the tiny orifice of an inhaler nozzle becomes ethylene glycol [antifreeze] when mixed with water, and God knows what else when mixed with meds and propellants and is inhaled..?

Cidex is good only for NON-disposable items made with materials that were made for and can handle such abuse.

Are you running your cidex-ed items through an approved dryer/dehumidifier after soaking?

I bet not.

If you were, you'd see the inhaler crumble after a short while.

Single use is single use. They're just not made for cleaning and JCAHO will bust you for it.

Best bet is to just bring the assigned inhaler to the IM instead of grabbing a new one, and get with your mgmt and push for inhalers for asthmatics to be kept on person.

Good luck!

rb

[NurseLite]

In our facility, the inmates KOP their inhalers (unless they are steroidal). Period. If they are found to abuse them, they are taken and if they need to be treated for an acute attack, they get a neb tx. Who has time to be running up to pods and blocks because "Inmate 123456" needs a hit off his/her inhaler ...

Although, the thought of "orificenic and Old Lace" via Cidex is increasingly intriguing ...

[kito4149]

In this facility, inhalers are OPMs (on person medication). If the i/m uses his inhaler before the 30 day reorder, then he is SOL (**** outta luck). If an i/m has a justified, legitimate script for breathing txs, he uses his neb tubing over again- we don't throw them away- the i/m rinses it out, puts it in a bio bag with his name, rack and i/m id # for the next time. Talk about saving mula!!

[Truegem]

We don't do the self-carry thing. Too bad, I wish we did.

Anyway, Randy, we aren't using Cidex, it was just something I had suggested. Thanks for the info.

I just hate wasting an inhaler for those one time use things. We were soaking them in a 10% bleach solution, but you're probably right. If you're not supposed to, then I get it.

I can tell you this WAS about germs, though. That's what everyone's argument was in the meeting we had where we discussed this. So anyway, it sounds like it's for the best that we're doing this, for reasons other than germs. Thanks everyone!

P.S. It's way too far to bring their inhaler when it's in another area. They may have just been rehoused in a building across town! We are a huge facility.

[Truegem]

P.S. Meth addicts love inhalers for the stimulant effect, so be careful about self-carry.