Leeds West CCG Paediatric asthma project. January 2015-January 2017 Aims to raise asthma awareness improve care reduce emergency attendances and unplanned admissions to secondary care for children with asthma in Leeds West.
The team Clinical Lead Practice nurse support School nurse educator
Who have we worked with? GP practices in Leeds West Secondary Care Pharmacists School Nurses Schools (staff and pupils) Early Years Health Visitors Leeds City Council
NRAD recommendations and our project Primary Care Patients with asthma must be referred to a specialist asthma service if they have required < two courses of systemic corticosteroids, in the previous 12 months. Follow-up arrangements must be made after every attendance at an emergency department or out-of-hours service for an asthma attack. Secondary care follow-up should be arranged after every hospital admission for asthma, and for patients who have attended the emergency department two or more times with an asthma attack in the previous 12 months. Electronic surveillance of prescribing in primary care should be introduced to alert clinicians to patients being prescribed excessive quantities of short-acting reliever inhalers, or too few preventer inhalers. All asthma patients who have been prescribed more than 12 short-acting reliever inhalers in the previous 12 months should be invited for urgent review of their asthma control, with the aim of improving their asthma through education and change of treatment if required. Health professionals must be aware of the features that increase the risk of asthma attacks and death Ref: https://www.rcplondon.ac.uk/projects/outputs/why-asthma-still-kills
NRAD recommendations and our project Primary Care Patients with asthma must be referred to a specialist asthma service if they require management using British Thoracic Society (BTS) stepwise treatment 4 or 5 to achieve control. The use of combination inhalers should be encouraged. Where long-acting beta agonist (LABA) bronchodilators are prescribed for people with asthma, they should be prescribed with an inhaled corticosteroid in a single combination inhaler. Ref: https://www.rcplondon.ac.uk/projects/outputs/why-asthma-still-kills
NRAD recommendations and our project primary care A standard national asthma template should be developed to facilitate a structured, thorough asthma review. This should improve the documentation of reviews in medical records and form the basis of local audit of asthma care. All people with asthma should be provided with written guidance in the form of a PAAP An assessment of recent asthma control should be undertaken at every asthma review. Where loss of control is identified, immediate action is required. An assessment of inhaler technique to ensure effectiveness should be routinely undertaken and formally documented at annual review, (and also checked by the pharmacist when a new device is dispensed.) Non-adherence to preventer inhaled corticosteroids is associated with increased risk of poor asthma control and should be continually monitored A history of smoking and/or exposure to second-hand smoke should be documented Factors that trigger or exacerbate asthma must be elicited routinely and documented in the medical records Ref: https://www.rcplondon.ac.uk/projects/outputs/why-asthma-still-kills
NRAD recommendations and our project Schools and Early years Parents and children, and those who care for or teach them, should be educated about managing asthma. This should include emphasis on how, why and when they should use their asthma medications, recognising when asthma is not controlled and knowing when and how to seek emergency advice. Ref: https://www.rcplondon.ac.uk/projects/outputs/why-asthma-still-kills
Number of Episodes of Children admitted to LTHT with asthma in 2008 120 100 80 60 40 20 0 jan feb marc h apr may jun july aug sept oct nov dec Series1 24 27 22 19 20 29 22 19 98 40 20 16
Monthly A&E attendance per 1000 QOF asthma registered patients for Leeds (2012 2014)
Asthma Friendly Schools & early years Staff training Asthma Policy Asthma register Immediate access to own inhalers Purchase of emergency salbutamol* Text to parents (prior to school holidays) * schools only
What has the project achieved so far? Paediatric asthma education has been delivered to practice nurses in Leeds West (30/36.) 21/36 practices are now using the asthma template and utilising the at risk of asthma exacerbation tool. Audit results have improved significantly since baseline Encouraging standardised care through the use of the new template and protocols 11 schools in Leeds West now have Asthma Friendly school status 20 schools have received asthma education 5 children centres have received asthma education Video production by children for other schools. Improved communication between primary, secondary care, schools and local pharmacies
Next steps To continue to work with member practices to embed new ways of working and ensure sustainability. Continue to collect audit data every 3 months and evaluate and share the results. Share the learning with the other CCG s in Leeds (and wider) Continue to work with the school nursing team to ensure sustainability of school support Continue to build relationships with secondary care and pharmacists. If you would like to know more about this project please feel free to email me at sophietoor@respiratorymatters.com