Conclusion

Summary of Conversation

1. Confirm or coach proper technique to decrease risk of readmission
2. Assess the patient’s technique using the checklist (give them the patient version)
3. Refer to RT or pharmacist if errors remain following two attempts
4. While assessing technique identify potential non-adherence, making it easy for them to reveal they find it hard to use inhalers regularly.
5. Explore patient’s beliefs about COPD; perceived need, perceived benefit. Listen, reflect, summarize
6. Ask permission, to suggest what they can do to help reduce risk of admission and improve (long term) symptoms
7. Use TeachBack process to confirm patient and family have understood information. Can they explain to their relative how their long-acting inhalers will help them?
8. Does the patient have any concerns about using their inhaler? How confident are they (out of 10), that they can and will use? (If less than 8, what can they think of to help them be an 8?)
9. Prior use of action plan: If the patient is presenting to the Emergency Department, find out if the patient used an action plan before coming to hospital in response to worsening COPD/asthma  symptoms (took additional medications for worsening COPD symptoms or did they adjusted their steroid inhaler inhaler for worsening asthma symptoms).  
10. Future use of action plan: Assess if the patient or family has the capacity to recognize yellow level symptoms of a COPD action plan, if so remind the physician to order this before discharge. Self-initiation of COPD action plans, also avoid visits to physician and hospital.