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Informing Patients about Empty Inhalers

Estimated timings:
2-4 weeks to set up & run the project (steps 1-2)
2-4 weeks if including reviewing the project (step 3)

Can be done by a GP, Pharmacist, Trainee or Student

Green Impact for Health Toolkit area: Prescribing & Quality Improvement

CQC Areas

  • Safe (Medicines Optimisation)
  • Well-led (Environmental Sustainability)

On this page

The benefits of this project

Project benefits for Your Patients

Benefits for Your Patients

  • Improved safety of asthma patients through reduced use of empty inhalers.
  • Enhanced patient education and self-management.
Project benefits for Your Practice

Benefits for Your Practice

  • Decreased risk of undertreatment of patients.
Project benefits for The Planet

Benefits for The Planet

  • Reduce the environmental impact associated with premature disposal of pressurised metered dose inhalers.

Opportunity for improvement

  • Important: This is a quality improvement resource only and not clinical guidance. Users must follow local and national guidelines and review disclaimers and carbon footprint methodology before starting. Clinical responsibility lies with the user.
  • Ensuring patients can tell when their inhaler is empty is essential for both clinical and environmental reasons. Many pMDIs do not have dose counters and therefore it is difficult for patients to know when the device is empty. This risks both waste of inhalers (throwing them away while they still contain usable medication doses) and undertreatment (continuing to use an inhaler which is not delivering any active medication).
  • This project outlines how to put these recommendations into practice. 
  • You might like to make a SMART goal for this project, e.g. Add patient information on dose counters to asthma review invites within 2 weeks. Educate practice team on importantce of dose counters and include Visual Aid on optimising asthma reviews on desktop within 1 month.

How to carry out this project

  1. Send information to patients

    Search for all patients prescribed inhalers. 

    We have collaborated with Primary Care IT who have created bespoke searches for all our asthma toolkit projects for SystmOne and EMIS users.

    For practices using SystmOne, request here: SystmOne free resources – Primary Care IT

    For practice using EMIS, request here: EMIS free resources – Primary Care IT

    Check your junk folder if you can’t see the email from PCIT in your inbox. See here for how to upload the searches.

    The search for this project is in the Disposal folder and is called GIP-160) Inhaler issues in last 12 months.

    Send information to these patients about how to tell if their inhaler is empty. This information could be incoprporated into their annual invite review.

    Resource: Example text message

    Do you know how to tell if your inhaler is empty? Ask your pharmacist or check here for more info: https://greeninhaler.org/telling-if-your-inhaler-is-empty/

  2. Educate the team

    Do the other clinicians in your team know how to tell if inhalers are empty? Do they know about the environmental and clinical risks associated with patients using inhalers without a dose counter? Could you arrange a brief update, perhaps at a clinical meeting or by sending an email.

    You could conduct a brief survey of staff before and after the education session to evaluate staff knowledge on this topic and the impact of the teaching session.

    Prescribing inhalers with dose counters reduces the risk of patients using empty inhalers or disposing of them early. You can check if an inhaler has a dose counter here https://www.rightbreathe.com/?s.

    PrescQIPP have information leaflets and banners you can add to websites about this (section called patient information materials).

    We have created videos and leaflets on types of inhaler devices which can be sent to patients that include information about dose counters. See project on optimising inhaler device choice in asthma for SMS/AccuRx messages with bit.ly links to these resources.

    Resource: PrescQIPP

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  3. Study

    Review the results, summarise learning, share with practice team and decide if any changes are needed to improve the process.

    Decide when to repeat the project again and use the Project Monitoring form to keep track.

Top tip

Dowload the Visual Aid for Optimising Asthma Reviews onto your desktop to encourage a conversation about dose counters in every asthma review.

How to scale this project up or down

Please note - Use of this project requires NetworkPLUS membership. If you would like to share this project with others, please invite them to purchase their own membership—access must not be shared with non-members.

You could take this project to your PCN team. Ensure all practices have paid for membership.

Have you completed this QIP?

Tell us a little about your project in order to generate a certificate showing the probable benefits. This project may help with CQC evidence submission (see disclaimers).

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