(346) Improving Spacer Usage for Out-patient Cystic Fibrosis (CF) Clinic

Background: The release of Trikafta has changed the lives of countless CF patients throughout the world. With this change came unexpected modifications to patients' breathing treatment regimen. Many patients now do not tolerate some medications while other patients simply have opted to stop using their treatments routinely. This topic is important to explore now because spacer education tends to be overlooked during our respiratory annual education review. A decrease in routine inhaled treatment use can lead to a decrease in proper infection control. Because of this, centers’ respiratory therapists (RRT) noticed that spacer education was lacking during annual respiratory review with patients. The aim of this project was to improve patients’ spacer proper use by 20% for patients seen between 1/1/22 through 4/1/22.

Methods: The process began when the clinical RRT gave both pediatric and adult patients a survey prior to spacer education. The survey consists of 4 questions focusing on: usage, cleaning, replacement, and technique. During the patient’s appointment, the RRT would go over the answers and remind/educate patients on proper spacer use and replacement. If needed, the RRT would also send an order for a new spacer. A post survey was then given to the same patients after at least one week. Responses for both surveys were recorded to compare.

Results: A total of 107 patients completed the initial pre-education survey. 61 patients (57%) stated that they use their spacer all the time, 8 (7%) use it half the time, and 23 (21%) never use it. 36 patients (34%) reported they replaced the spacer once a year, 8 people (7%) replace their spacer twice a year, and 36 (34%) stated that they never replace their spacer. 11 patients (10%) said that their spacer whistled during use. Of the 107 patients, 39 also completed the post-education survey. 27 (57% of patients) stated that they use their spacer all the time, 6 (7%) use it half the time, and 0 said they never use it. 24 patients (62%) once a year, 4 (10%) reported they replaced the spacer twice a year. 3 patients (8%) said that their spacer whistled during use. This showed an improvement of 20% of patients using their spacer either all the time or half the time and an increase of 29% of patients replacing their spacer routinely.

Conclusions: Both the pediatric and adult centers were able to meet the 20% goal of using a spacer with inhaler treatments. We also showed an increase in patients replacing spacers. We had an opportunity to increase the potential for medication delivery by communicating with each patient about their spacer usage and replacement. We will continue to implement this education during clinic visits where we were able to see an improvement. The benefits of our annual review become clear in its effectiveness when we are able to see positive results like this. Moving forward, we will increase our sample size with time and center growth, distribute the survey again before the next annual respiratory review to see if the patients are able to retain education, or invite other centers to join us.

Acknowledgements: Adult CF Center of Central Texas
Pediatric CF Center at Dell Children's Medical Center

References: Richards, K., Seidelman, J., & Lester, M. (2013). Cystic Fibrosis Respiratory 101: Getting Started. Retrieved from https://portcf.cff.org/