ORAL SKILLS COUNSELLING EXAMINATION (OSCE)

Asthma/COPD & Inhaler Techniques

Name of PRP : _________________________ Date : __________

Name of Examiners : _________________________
Peer-review score : _________________________
Peer-review done by PRP : _________________________

Introduction Subtotal: /4
Introduction name & PRP status I
Why the need to counsel/discuss I
1a. ASTHMA education Subtotal: / 16
What is asthma disease & pathophysiology C
Role of bronchodilator vs preventer & MOA C
Inhalers regimen & dosage C
Sequence of inhalers I
Maximum number of puffs for reliever inhaler I
Mouth rinse after steroid puff & why C
1b. COPD education Subtotal: / 16
What is COPD disease & pathophysiology C
Role of inhalers in COPD & MOA C
Inhalers regimen & dosage C
Sequence of inhalers I
Maximum number of puffs for reliever inhaler I
Mouth rinse after steroid puff & why C
2. Inhaler technique assess at least 3 types of technique (choose from 2a-2f)
2a. MDI Subtotal: / 50
1. Shake MDI before use C
2. Priming for 1st time use & more than 2 wks not used I
3. Remove MDI cap & hold it upright C
4. Exhale until as if lungs void of air C
5. Seal lips tightly onto MDI mouthpiece C
6. Press the canister & immediately inhale as deep as possible C
7. Hold breath ~10s C
8. Remove MDI from mouth & breathe out slowly B
nd
9. Repeat technique after ~ 30s for 2 dose C
10. How to tell empty MDI (shake & weigh, OR calculate dose & date) C
How to clean MDI
11. Remove mouthpiece cover & canister from device C
12. Do not immerse the metal canister I
13. Wash mouthpiece through inhaler top under running tap water ~ 30secs C
14. Invert to wash through mouthpiece ~ 30 secs C
15. Leave to air dry overnight after shaking off excess water C
16. Do not wipe parts C
17. When it is dry, fix back together I
18. Shake device well & press canister to ensure no blockage I
19. Clean device after last dose, at least once a week to prevent blockage I
2b. MDI + Aerochamber Subtotal: / 48
1. Check Aerochamber for foreign objects B
2. Remove MDI cap C
3. Shake MDI before use C
4. Insert MDI into the back of Aerochamber C
5. Apply mask to cover mouth & nose & seal tightly C
6. Depress MDI once C
7. Maintain good seal for 5 breaths after depressing MDI C
8. Check that whistle sounds are not produced. Slow down if occurs C
9. Repeat technique after ~30s for 2nd dose C
How to clean Aerochamber/Diamond
10. Remove the parts (do not remove mask for Aerochamber) C
11. Soak both parts in warm water with mild detergent for 20 mins C
12. Gently agitate to dislodge dirt & rinse off with water C
13. Shake out excess water B
14. Let air dry in vertical position (do not directly expose to sunlight) C
15. Do not wash/wipe/rub inside part of Aerochamber with cloth/any object C
16. Fix it back when completely dry B
17. Clean at night time after last dose I
18. Clean once every 1-2 weeks C
19. Where to get stock & price B

2c. Accuhaler Subtotal: / 27

1. Push the notch to open C
2. Slide the level until it clicks C
3. Before inhaling, exhale away from device till as if lungs void of air C
4. Do not breathe into device as breath moisture can damage device C
5. Seal lip onto mouth piece & inhale as deep as possible C
6. Remove Accuhaler and hold breath for ~10s C
7. Sweet taste to confirm dose taken B
8. Push the notch to close I
9. Clean after use by wiping the mouthpiece with dry tissue only C
10. How to tell empty Accuhaler C

2d. Turbuhaler Subtotal : / 27

1. Remove cap C
2. Hold it upright & turn the red base to far right C
3. Then twist the red base to far left until it clicks C
4. Before inhaling, exhale away from device till as if lungs void of air C
5. Breathe in forcefully & deeply through mouth C
6. Do not need to hold breath B
7. Repeat technique from step 2 for 2nd dose C
8. Clean after use by wiping the mouthpiece with dry tissue only C
9. Screw the cap back on to keep. Do not turn red base again I
10. How to tell empty Turbuhaler C

2e. Handihaler Subtotal: / 53

1. Open the cap & mouthpiece C
2. Remove Spiriva capsule from blister pack only before use C
3. Tear along the perforated line of blister pack & remove capsule I
4. Place capsule in the centre chamber C
5. Close the mouthpiece firmly until it clicks C
6. Press the piercing button completely in once & release C
 7. Before inhaling, exhale away from device till as if lungs void of air C
8. Do not breathe into device as breath moisture can damage device C
9. Close lips tight around mouth piece C
10. Breathe in slowly & deeply, sufficient to hear the capsule vibrating C
11. Breathe until lungs are full & hold breathe as long as comfortable C
12. Resume normal breathing, repeat step 6-10 to fully empty capsule I
13. Open mouthpiece & tip out capsule for disposal I
14. Close mouthpiece & cap after use I
How to clean Handihaler
15. Open cap & mouthpiece C
16. Open the base by lifting the piercing button (side green button) C
17. Rinse Handihaler with warm water to remove any powder C
18. Dry device thoroughly by tipping excess water on tissue B
19. Air dry for 24 hours, leaving cap, mouthpiece & base open C
20. Clean once a month I

2f. Easyhaler Subtotal: / 31

1. Open the cover & remove mouthpiece cap C
2. Shake device vertically C
3. While holding vertically, depress canister until it clicks C
4. Before inhaling, exhale away from device till as if lungs void of air C
5. Do not breathe into device as breath moisture can damage device C
6. Seal lip onto mouthpiece & breathe in quickly & deeply C
7. Remove device & hold breath for ~5s B
8. Sweet taste to confirm dose taken C
9. Repeat step 2-7 for 2nd dose, after ~1 min C
10. Clean after use by wiping the mouthpiece with dry tissue only C
11. How to tell empty Easyhaler C

General points Subtotal: /7

Ask for feedback B
Language, layman terms B
Flow of counselling B
Eye contact B
Preparation of tools (leaflet, inhaler placebos, assessment form) B
Exchange policy for subsequent supplies I

Marking scheme:
a. C = 3 pts, I = 2 pts, B = 1 pt
b. Fail if more than 3 Cs missed
c. Overall passing mark = 70%

No. of Cs missed : _____________________

Total score achieved : _____________________
Total score assessed : _____________________
Percentage achieved : _____________________ % (Pass/Fail)
1st review by Lysia
nd
2 review by Yinkey/Ginni (Dec 2010)
rd
3 review by Yinkey & clinicals (Feb 2013)