Peak Flow Meter PFM  or now termed as Peak Expiratory Flow Rate is another simplest skill you might get to demonstrate for your NMC OSCE Exam. Time limit is changed to 8 minutes from previous 15 minutes. During this eight minutes you need to introduce peak flow meter to patient, demonstrate its use, return demonstration from patient, taking note of highest reading within acceptable limits, explaining patients reading with regard to the chart given with the scenario, explaining after care of Peak Flow Meter, maintenance of diary as well as education about ways to improve their lung capacity.

Peak Flow Meter PFM Procedure for NMC OSCE Skill Demonstration

Let me remind you that this is one of the simplest skills you may get to demonstrate for your NMC OSCE Exam. Procedure can be broadly classified under the following headings. Assume you are the candidate while reading the steps.

Introductory Phase

• Entering the patient room, checking for scene safety, ensuring that scene is safe to approach
• Protecting the privacy and dignity of patient by closing the curtains and doors
• Doing the hand rub using seven steps of hand hygiene
• Hello, myself ‘name of candidate’ and am your attending nurse today
• Can you tell your name please
• What can i call you?
• Can you tell me your date of birth?
• Can i confirm the same with your id tag (Name, date of birth, hospital number)
• How are you now?
• Are you comfortable?
• Do you have Asthma?
• Do you know any allergens that can trigger an Asthma attack to you?
• Are you in any pain now? (If patient tells that he/she is in pain, you need to score pain using pain assessment tool)
• Have you taken any bronchodilator drug or used your inhaler now? (If yes, you need to wait for 30 minutes to take a PFM reading)

Introducing Peak Flow Meter

• Have you used Peak Flow Meter before?
• If yes, do you know the proper technique of using PFM, What was your highest PFM reading when you used it?
• IF no, i am hear to introduce you about how to use a Peak flow meter or PFM

Purpose of Peak Flow Meter

• Peak flow meter is used to get a reading which is called Peak flow meter reading. It is used to measure the rate at which you can exhale out after a deep inspiration
• Peak flow value also helps to know the degree of obstruction in your airway and how well you are responding to your asthma treatment
• Are you ready to use peak flow meter now?
• Do you need to use the toilet now? Procedure will take another 15 minutes for demonstration and return demonstration, is it okay with you?
• Are you in a comfortable position? Is the room temperature okay for you?
• I will assemble the articles and come back to you now, meanwhile if you need anything or any assistance please call me or press the call bell, okay?

Assembling Articles and Hand Washing Phase

You need to verbalize the following,

• I am doing hand washing using the seven steps of hand hygiene at the wash basin provided
• I am wiping my hands with the paper towel from finger to the wrist and discarding it in domestic waste
• I confirm with the examiner that this tray is cleaned with soap and water in past 24 hours (No need to clean again)
• I confirm with the examiner that this PFM is cleaned and calibrated for safe use
• I will assemble the articles needed in this tray, an alcohol wipe, a pair of gloves, disposable mouth pieces (2) and peak flow meter
• I will take the tray to the patient side and do a hand rub

Procedure

• Hello, are you comfortable in this position, shall we begin?

Positioning for Peak Flow Meter

• Peak flow meter should be used either in a sitting upright position or standing position, which one do you prefer?
• You should note that you use the same position while taking every peak flow reading afterwards, okay?

Explaining Parts and Usage

• This is the peak flow meter, this is the mouth piece which is disposible (you can also get a permanent one) and this the gauge of peak flow meter with a pointer
• You should keep the mouth piece in your mouth sealing with lips properly (not biting with teeth and not obstructing the airway with your tongue) making sure that you are not flexing your neck
• Ensure your pointer is at zero and hold peak flow meter horizontally without touching the gauge
• You should take a deep breath and exhale immediately as fast as you can (like a huff)
• The pointer will move like this, Peak flow meter reading is recorded in liters/minute, record the reading on a paper
• Repeat the procedure 2 more times
• If the peak flow values you have got is more than 40L/minute apart you need to take two more readings
• Now you have to take the highest value among three acceptable readings (those which are not more than 40L/minute apart)
• Don’t spit air as it will affect your reading

Demonstration Phase

• Do you want me to demonstrate it for you? (Possible answer is no from the examiner)
• Are you ready to give it a go?

Redemonstration Phase

• Seal your lips around avoiding tongue and teeth to obstruct your airway, take a deep breath and exhale as quickly as you can
• Examiner will give you three readings, which you have to note on the paper
• Explain to the patient that which one is their highest reading

Chart Depiction Phase

• Take the peak flow meter chart (given during exam)
• This is the chart which shows maximum peak flow values you can obtain in regard to your age and height
• What is your age and what is your height?
• So your maximum possible value should be —–(show in chart), you got a value of —– which means you still need to improve your PFM value

Recording of Peak Flow Readings at Home

• You have to take peak flow meter reading twice every day at home before having your asthma medication ie either bronchodilator tablet or your inhaler (one in the morning and one in evening)
• You need to record this in a diary and bring with you when you are next time visiting the hospital
• This will help your physician to understand how well you are responding to your therapeutic regimen

After Care of Peak Flow Meter

• You need to clean your Peak flow meter with an alcohol wipe after every use and need to dry it open
• You need to wash your PFM after every 30 use with a detergent and water, then sterilize it using any bottle sterilizer like milton, then dry it open
• You need to change your peak flow meter after a year of use

Doubt Clearing Phase

• So, is every thing clear and understood? Do you have any doubts?

Health Education Phase (If you have extra time only)

• Now, let me tell you some more techniques to improve your lung capacity. You need to do deep breathing exercises at home (Inspiring maximum air in, holding it few seconds and exhale slowly), you can also do inflating a balloon and also some aerobic exercises as your physician would suggest
• So, that’s all about peak flow meter, do you have any queries or concern?
• You will be getting one of these when you are discharged, meanwhile i will document the highest reading you have got this time, okay?
• Here is your call bell, feel free to call me or press the bell in case of any assistance, thank you for your cooperation

Cleaning Phase

• Now after a hand rub am going to clean the peak flow meter using alcohol wipe after wearing a glove, then i will leave it open to dry
• Discard gloves and do a hand rub
• Document highest reading obtained along with date time and signature
• Open the curtains back
• Leave the room after doing a hand wash or hand rub using seven steps of hand hygiene.

Conclusion

That’s all about using of peak flow meter and recording patients peak flow readings. Don’t forget to tell about proper placement of PFM, Recording of highest of three acceptable readings as well as use of Peak Flow meter at home.

We are also adding a flow chart video of how to demonstrate peak flow meter as skill for NMC OSCE Exam which you can watch here. Please note that time limit is changed to 8 minutes now.

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