Administering Nebulised Medication – OSCE Guide

This administering nebulised medication guide provides a step-by-step approach to setting up a nebuliser and administering nebulised medication in an OSCE setting. Administering nebulised medication may be assessed in an OSCE as an individual skill or as part of an ABCDE assessment.

Nebulisers

Nebulisers quickly and easily administer high doses of medication required for patients with severe or life-threatening respiratory conditions.^1,2

Nebulisers change the liquid medicine into a fine mist that the patient inhales through a facemask or mouthpiece. Nebulisers can be used for all ages, as different sizes of facemasks are available.¹

Gather equipment

Gather the appropriate equipment:

• Non-sterile gloves
• Apron
• Equipment tray
• Oxygen tubing
• Oxygen face mask or mouthpiece with a nebuliser
• Syringe (the smallest syringe that will accommodate the medication volume)
• Drawing-up needle (also known as a blunt filter needle): filters out sub-visible particles of glass, rubber and other residues when drawing up medications from ampoules
• Sharps container
• The medication to be administered
• The patient’s prescription

Nebulisers can be oxygen-driven or air-driven. Oxygen-driven nebulisers are connected to an oxygen source (e.g. portable oxygen cylinder or piped oxygen supply). Air-driven nebulisers use compressed air. 

Introduction

Wash your hands and don PPE if appropriate.

Introduce yourself to the patient including your name and role.

Confirm the patient’s name and date of birth.

Briefly explain what the procedure will involve using patient-friendly language: “Today I need to administer some medication; this will be using a nebuliser which will turn the medication to mist. You will need to breathe in the mist by wearing a facemask or using the mouthpiece until all the medication is administered. You may experience a dry mouth and eyes. There is a small risk of eye and mouth irritation.”

Check the patient’s understanding of the medication being administered and explain the indication for the treatment.

Gain consent to proceed with administering nebulised medication.

Check if the patient has any allergies.

Position the patient so that they are sitting comfortably.

Final checks

Before proceeding, check the seven rights of medication administration.

1. Right person: ask the patient to confirm their details and then compare this to the patient’s wristband (if present) and the prescription. You should use at least two identifiers.

2. Right drug: check the labelled drug against the prescription and ensure the medication hasn’t expired.

3. Right dose: check the drug dose against the prescription to ensure it is correct.

4. Right time: confirm the appropriate time to administer the medication and check when the patient received a previous dose if relevant.

5. Right route: check that the planned route is appropriate for the medication you are administering.

6. Right to refuse: ensure that valid consent has been gained before medication administration.

7. Right documentation of the prescription and allergies: ensure that the prescription is valid and check the patient isn’t allergic to the medication you will administer.

Once all of the above has been confirmed, prepare the medication.

Administering nebulised medication

1. Wash your hands and don PPE (if not already done).

2. Assemble the nebuliser device according to the manufacturer’s instructions.

3. Pour the correct dose of medication into the nebuliser device. Keep the nebuliser upright to avoid spilling the contents.

• If the volume of medication required differs from the volume in the nebule, you will need to draw up the required volume into a syringe using a drawing-up needle.
• Remove the drawing-up needle and immediately dispose of it into a sharps bin, then pour the medication into the nebuliser device.
• Some medications may require the addition of saline for dilution.

4. Position the patient upright (greater than 45 degrees) to ensure optimal lung expansion and medication distribution.

5. Attach the nebuliser onto the face mask or pipe system with a mouthpiece as appropriate.

6. Attach the oxygen tubing to the bottom of the nebuliser device. Attach the other end of the oxygen tubing to an oxygen supply or compressed air.

7. Turn on the oxygen or compressed air to a flow rate to provide sufficient misting (around 6-10 litres per minute).

8. Secure the facemask over the patient’s mouth and nose or instruct them to seal their lips around the mouthpiece. This ensures proper inhalation of the medication. If the patient is receiving oxygen via nasal cannulae, continue to deliver this with the nebuliser.

9. Instruct the patient to try and inhale slowly and deeply during administration to maximise the effectiveness of the medication.

• If an anticholinergic medication (e.g. ipratropium bromide) is being administered, the patient may find it more comfortable to close their eyes to avoid irritation.

10. Run the nebuliser for around 10 minutes until the total dose of medication in the nebuliser chamber has been administered.

11. Continue to monitor the patient’s vital signs and monitor for any side effects of medication administration.

• It is important to monitor the patient when administering medications, particularly beta-adrenic bronchodilators, as cardiac side effects (e.g. tachycardia) can occur. 
• Patients with COPD may be at risk of hypercapnic respiratory failure, especially when oxygen is administered.

12. Towards the end of treatment, inspect the nebuliser and tap the side of the chamber to release any droplets clinging to the side to ensure the entire dose is administered.

13. Once the administration is complete, turn off the oxygen or compressed air and remove the facemask or mouthpiece from the patient.

• If administration included steroids, ask the patient if they would like to rinse their mouth to remove residual medication and help prevent oral candidiasis (thrush) related to steroid use.

14. Re-assess the patient’s vital signs and conduct a respiratory examination to determine if the administration of nebulised medication has had the desired effect or if further treatment is required.

15. Dispose of your equipment into an appropriate clinical waste bin.

To complete the procedure…

Explain to the patient that the procedure is now complete.

Thank the patient for their time.

Dispose of PPE appropriately and wash your hands.

Document the details of the procedure and the dose of medication administered.

References

1. Asthma and Lung UK. Nebulisers. 2023. Available from: [LINK]
2. National Institute for Health and Care Excellence. BNF Treatment Summary -Asthma, acute. 2023. Available from: [LINK]
3. British Thoracic Society and Scottish Intercollegiate Guidelines Network. British guideline on the management of asthma, Full guidance – A national clinical guideline. 2019. Available from: [LINK]