Clinical audit in ENT

1. CLINICAL AUDIT ON THE STEROID
NASAL SPRAY TECHNIQUE

2. INTRODUCTION
• Nasal spray is used to treat symptoms of
allergic rhinitis, sinus as well as blocked nose.
• A correct technique is essential for effective
delivery of the medicines.
• Hence increasing the effectiveness of the
therapy.

3. Objective
To investigate if patients use a correct technique
while administering steroid nasal spray

4. Criteria
Inclusion
o Steroid nasal spray user
o Patient in ORL
Exclusion
o Other nasal spray user:
-decongestant
-saline
o Patient unwilling to give
consent

5. Data collection
o This survey will be conducted at ORL clinic.
o A standardized nasal spray checklist will be
distributed among the patients who were
using steroid nasal spray.
o Data collection will be start in February 2023
o We will choose pt randomly in ORL clinic who
are using nasal spray.

6. Nasal spray checklist
http://www.myhealth.gov.my/en/how-to-use-nasal-spray/

7. Nasal spray checklist
Priming Yes (%) No
1.Prime the nasal spray for the first time. Shake well and remove cap 51 (81) 12
2.Pump the bottle until a uniform mist appears 36 (57) 27
Administration Yes No
3.Blow nose gently before spraying ( if blocked ) 19 (30) 44
4.Shake nasal spray gently 51 (80) 12
5.Remove cap 63 (100) 0
6.Hold nasal spray upright, thumb beneath bottle and fingers on either side of
nozzle
63 (100) 0
7.Close one nostril with finger. Tilt your head forward slightly and keeping the
bottle upright , carefull insert the nozzle into the other nostril
31 (49) 32
8.Point the nozzle away from centre ridge of your nose, towards the outside
corner of your eye on the same side
48 (76) 15
9.Breathe in gently through your nose and press the pump firmly 63 (100) 0
10.Remove the nozzle from nostril and breathe out gently through mouth 60 (95) 3
11.Wipe the nasal applicator 51 (81) 12

8. RESULT
• Among the subjects prescribed, only 11 from
63 subjects able to score 11 on the tool used.

9. Implement change
• Emphasize the importance of verbal
instruction among medical officer
• Ask pt to do on appoinment
• Give pamphlet nasal spray technique

10. Reaudit

11. CONCLUSION
• The nasal spray use technique was poor among the
subjects before the intervention.
• The intervention was substantially effective in
improving the technique to use the nasal spray.
• Regular assesment and reinforcement of correct
technique by health professional will improve the
proper use technique of nasal spray, hence
increasing the effectiveness of the therapy

12. REFERENCE
• GARIS PANDUAN KAUNSELING UBAT-UBATAN
EDISI KE-3 TAHUN 2019
• http://www.myhealth.gov.my/en/how-to-use-
nasal-spray/