WATER EATON HEALTH CENTRE

ASTHMA PROTOCOL – MANAGEMENT PLAN

Aims

To provide improved care for our asthmatic patients, resulting in their improved health and a symptom-free lifestyle or one that is controlled

It is ouraim that patients gain a better understanding of their asthma and therapy,and will become more involved in self-management plans.

To reduce incidences of crisis management e.g. nebulisations, courses of oral steroids, acute hospital admissions, exacerbations and frequent attendances to a GP.

To improve and ensure good inhaler technique and put a self-management plan into place.

Objectives

To assess and review all patients diagnosed with asthma in the clinic at least annually.

The British Guidelines on Asthma Management (BTS) have been adopted in this protocol to ensure continuity of care and a consistent approach to asthma and its treatment.

Appointments will be flexible to suit the patient. Each initial consultation should be 30 minutes and then 20 minutes for any subsequent follow-up appointments.

All patients should be encouraged to contact their asthma nurse or doctor foradvice and reassurance if they encounter any problems.

Identification of Patients

Monitor new patient notes, as well as their attendance at new patient healthchecks and completion of the practice’s new patient questionnaire.The aim is toinvestigate the possibility of new patients’symptoms leading to the possibility of asthma.

In children, record the basis on which a diagnosis of asthma is suspected. In adults, initial diagnosis should be based on a careful assessment of symptoms and a measure of airflow obstruction. Spirometry is the preferred initial test to assess the presence and severity of airflow obstruction in adults.

Record Keeping

Information will be recorded using the appropriate read code within the clinical system on an approved template.

Initial consultation should investigate the following:

  • The patient’s full past medical history, including any seasonal variations and any allergies, including to pets, pollen and dust.
  • The patient’s height & weight.
  • Measure the patient’s peak flow if they are older than five and able to perform it.

Diagnosis should be made based on:

  • The patient’s history and symptoms
  • Reversibility > 15% after 15 minutes following 400mcg inhaled salbutamolvia volumatic.
  • Serial peak flow recordings for 2 weeks, looking for diurnal variation. Patients can be provided with a monitoring book.

Treatment

  • Teach peak flow monitoring where necessary.
  • Offer a basic asthma education with written reinforcement where appropriate, and produce a pathway for patients and/or carer to follow.
  • Discuss and select an inhaler device appropriate to the patient’s needs.
  • Teach and check inhaler technique.
  • Use BTS Guidelines to treat appropriately, according to age and severity of condition.
  • Ensure a follow-up appointment is made.
  • Add patient to asthma register on clinical system.
  • Advise on influenza and pneumonia vaccines as appropriate.

Subsequent Consultation

  • Spirometry referral to be made if appropriate to practice enhanced services team and reversibility.
  • Check recent symptoms, history and peak flow diary.
  • Measure peak flow and height again if appropriate.
  • Check inhaler technique.
  • Follow template and give asthma education.
  • Evaluate treatment and adjust accordingly.
  • Issue self-management plan according to patient’s age and level of understanding, involving them in the plan and the target levels and achievements to be made.

Recall of Patients

  • Follow-ups should be scheduled monthlyfor new and poorly controlled patients.
  • Regular follow-ups should be scheduledon at least an annually basis.

Referral of Patients

The nurse will referback to the GP for their opinion in the following circumstances:

  • Approval is required for a change in treatment, unless the nurse has prescribing qualifications. In this case, a GP’s advice can be soughtif the nurseneeds advice regarding management.
  • The patient requires oral steroids or is having an asthma attack, a nebuliser is available in the nurses’ cupboard and all members of staff are trained to use this piece of equipment.
  • A steroid trial is required to ensure correct treatment regime.
  • The patient is presenting with symptoms unrelated to asthma, in which case they should be booked in with a GP or Nurse Practitioner as appropriate.
  • The patient is experiencing side effects.
  • The nurse is generally concerned regarding the patient’s condition.

Staff Training

  • Nurses will have an Asthma Diploma.
  • HCAs to have training on carrying out Spirometry.
  • Nurses to have training on Spirometry interpretation.
  • Nurses to complete prescribing course wherever possible and receive annual update.
  • All staff in surgery to be shown how to use and manage the nebuliser.
  • Admin staff to be trained on re-calls system and reporting, appointment booking and waiting list referral management.
  • Where practices have a flare-up plan, meaning that patients can be fast-tracked to see the nurse for urgent treatment, alerts should be added to the patient’s clinical record and staff informed of this protocol.

Resources

BTS/SIGN British guideline on the management of asthma

NICE Guidance

Reviewed by Dr Faisal – July 2016

To be reviewed – July 2017