inhalers

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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.

Specializes in MICU, ER, SICU, Home Health, Corrections.

Well.. glad to try and help, but it kind of sounds like you're stuck in the big grinder of corporate meetings. No luck there, for sure.

Your root problem appears to be med access, not germs. I'd keep that in mind when I pushed for changes.

Just an idea for a temp fix.... let the IM keep the plastic, and the nurses can carry a couple popular inhaler canisters?

Hope you find a viable solution.

rb

Specializes in Pediatrics, Nursing Education.

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!

uh... i am kind of shocked this was even posted. anyone who goes through nursing school knows this.... it is not news?

i agree with the others. MDI's are not for single time, single patient use. Use a nebulizer and kit and throw away the kit afterwards - is smarter, more efficient, and cheaper than what you are doing now. I think it is disgusting to clean the canisters and use them again. Are you reusing needles too?! j/k, but still... it is that kind of attitude that leads people to reuse things that are completely inappropriate for reuse!

if someone did that to one of us in an office or to a family member, we would be outraged!! same thing... these people deserve to receive the standard of care, even if they are inmates!

Specializes in Oncology, Corrections.

Everyone keeps saying "use a nebulizer for a one time use". A nebulizer is not necessary in this situation. I just want to say, it's for their inhaler use, routine inhaler use. I'm talking about just someone that needs a couple puffs, not someone in acute distress. Yes, we use nebulizers...for more acute situations. That's a completely different story.

I just need to clarify so you all don't think we are using a little ol' inhaler for some emergency. That's not what I'm talking about at all. That is not the point.

This is when they are away from the area where their personal inhaler is kept and they want a couple puffs.

Jeepgirl, my point was that bleach kills germs extremely well. I don't find it gross at all. I'm only resigning myself to this change because of the potential for the plastic to break down, as Randy said. Otherwise, I believe that they are probably cleaner when cleaned with bleach than they were when they came out of the box. I would allow my infant to use it. Like I said, what about using the same fork that some other restaurant patron used, and it was only cleaned in a dishwasher? No bleach. Who knows who ate off of that fork? Clean is clean and the mouth is not a sterile area, as we learned in nursing school. Everything you put in your mouth does not need to be sterile. Also, for the record, I'm not talking about our facility being the one who cleans colonoscopy equipment and reuses it, it's common practice at hospitals. As far as nebulizer equipment...we don't throw it away, we clean it and label it with the patient's name for reuse by that same patient. Same thing they would do at home. Throw it away? Why? Also, I don't get how this is "cheaper than what we are doing now." I believe the nebulizer tubing is pretty expensive.

Specializes in Oncology, Corrections.

Randy, I don't think they're going to let the IM keep the plastic...couldn't they melt it down and make a weapon out of it?

Specializes in Pediatrics, Nursing Education.

neb kits around here, bought in bulk, are pretty cheap. 3-4 bucks a kit. a lot less expensive than some of the MDI's.

someone who only needs an MDI once should not have an MDI.

at least, not in my opinion.

if you keep the Neb kits that the inmates reuse - why can't you do the same for a little inhaler? and are they caring properly for the neb kits - cleaning and caring for them as they should, and tossing them when appropriate if using them for a long period of time? i know inpatient, usually a patient only needs one kit for one acute stay - because they get discharged within a few days after beginning its use.

but in the home setting, at least around here, we tell people to not use the kits for more than 2 weeks.

again - if you were to go to an ER or someplace and you needed a treatment (not in acute distress where we'd admit you, but you needed a treatment) like albuterol or xopenex, for instance, you'd get a neb rather than an MDI for a one time use. to see how you did, especially if you hadn't been on an MDI before. often however, when people leave the ER setting they end up with an MDI later on... if they still need the medicine most of the time - but that's besides the point. I'm just saying that if they only need it once, why use MDI vs. neb?

If these guys are using MDI's occasionally for asthma or other chest conditions, why can't one be kept for their use in a drawer or some sort of storage locker like that?

i guess i am confused as to why the storage is such a big deal. you know? especially if you can keep neb kits around but not the really expensive MDI's, which are much smaller.

Specializes in Oncology, Corrections.

Why do people keep talking about nebulizers? Ok, they are not ordered an inhaler for a one time use. They are ordered an inhaler QID PRN. When they are AWAY from their inhaler, like if they are being rehoused, and they need a little ol' puff of their inhaler, we have to open up a brand new one to give them a couple of puffs because their assigned inhaler is in another building far away. When they are rehoused in our facility, they go to an area to await housing. This could be way across town because we are such a huge facility we have several buildings in the county where they could be housed. In the situation that I am talking about for this conversation, they would not need a nebulizer treatment. It would be poor nursing to give someone a nebulizer treatment in the situation I'm talking about. I'm talking about routine inhaler use. Not urgent, not sickly, not in distress, not dying, not blue, no ER necessary, not even close to a sign of distress. We do keep their inhalers in a drawer all labeled and everything. But we have a lot of movement and often times they get rehoused by security. Their inhaler follows them, but not usually the instant they are being rehoused. Security doesn't notify us when they are moving, they just go. So sometimes they end up in a building different from where their inhaler is. It will eventually catch up to them, when we check and realize he moved we will send it there. But if he needs his inhaler in the meantime, the guard will bring the guy over to us and say "this guy says he needs his inhaler" and we assess him and if he's not bad off, we open a new one for him to use. Then we reassess him to make sure that is all he needed and that he's ok. We then throw away the mouthpiece and send the canister to the Pharmacy.

We do throw out nebulizer kits after a certain amount of time. I think it's one week, actually.

So, why not label the newly opened MDI and send it to the i/m's new unit?

Specializes in Oncology, Corrections.

Because he could be in the holding area for up to 24 hours and until then, we don't know where his new unit is. We will just have his original inhaler sent there when we find out where he's going.

You know what, never mind. This is just getting too convoluted and people don't know our system. I forgot I was talking to some very small jails and some prisons and it would be hard to understand if you don't work in a huge jail like I do. Huge facility and high turnover = lots of creative ways to do things. There's probably not as much movement in the prisons and in the smaller jails, they probably don't move as far so it's hard to understand when I say they don't have their personal inhaler handy.

Thank you all for your responses! =)

Specializes in MICU, ER, SICU, Home Health, Corrections.

Well... lemme see...

Melting down an MDI sleeve would probably net one pretty short and skinny shank. I'd be more afraid of a pencil in their hands. Plus, take a minute and think of all the plastic combs, shaving razors and whatnot that are already in use.

On the MDI front, Jeepgirl... TrueGem is apparantly having a problem with availability of a med across a long way. If an IM gets shot over to z-block and the meds are kept near a-block, it will be a long time coming before the med gets hoofed down there to them. That is the real issue. So in that instance it may be easier for them to pop out a new inhaler. It isn't about germs or HHN's vs MDI's.

However; her facility is indeed facing a definite flow and storage problem. I hope they can find a solution!

On a federal level, we have compressors in metal cages mounted on the walls, and the IM's just do their own nebs at the wall station, just like home care. Prescribed meds are kept on person.

I'm not sure what to suggest to 'gem except to let the IM keep the plastic.

good luck to you all!

rb

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;

Why can't an MDI be used repeatedly by the same inmate and only that inmate?

does Single Use mean 1 use by 1 patient and done or does it mean 1 patient uses it until it expires or becomes empty or what?

Why do people keep talking about nebulizers? Ok, they are not ordered an inhaler for a one time use. They are ordered an inhaler QID PRN. When they are AWAY from their inhaler, like if they are being rehoused, and they need a little ol' puff of their inhaler, we have to open up a brand new one to give them a couple of puffs because their assigned inhaler is in another building far away. When they are rehoused in our facility, they go to an area to await housing. This could be way across town because we are such a huge facility we have several buildings in the county where they could be housed. In the situation that I am talking about for this conversation, they would not need a nebulizer treatment. It would be poor nursing to give someone a nebulizer treatment in the situation I'm talking about. I'm talking about routine inhaler use. Not urgent, not sickly, not in distress, not dying, not blue, no ER necessary, not even close to a sign of distress. We do keep their inhalers in a drawer all labeled and everything. But we have a lot of movement and often times they get rehoused by security. Their inhaler follows them, but not usually the instant they are being rehoused. Security doesn't notify us when they are moving, they just go. So sometimes they end up in a building different from where their inhaler is. It will eventually catch up to them, when we check and realize he moved we will send it there. But if he needs his inhaler in the meantime, the guard will bring the guy over to us and say "this guy says he needs his inhaler" and we assess him and if he's not bad off, we open a new one for him to use. Then we reassess him to make sure that is all he needed and that he's ok. We then throw away the mouthpiece and send the canister to the Pharmacy.

We do throw out nebulizer kits after a certain amount of time. I think it's one week, actually.

Why can't their inhalers be sent with Custody personnel when the inmates are moved to a different building? Is there a nurse in the new place to receive inhalers, med charts, pertinent report?

Or could the inhalers be the responsibility of Custody, such as when someone wants a Tylenol?

Not ideal, this last suggestion, I know.

I don't think the bleach is as destructive as we are thinking it is, is it?

Specializes in Oncology, Corrections.

Custody personell? Since when do they care about an inmate's health? This is a totally new concept to me. Our custody personell aren't allowed to give a Tylenol or any meds at all and probably aren't even allowed to transport meds now that I think of it.

:p

Yes, single patient use means only that patient can use it.

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