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Development of a care pathway to improve the management of asthma or viral induced wheeze for children admitted to the paediatric unit at Wishaw General Hospital
  1. K Stock,
  2. L J McAulay,
  3. E Anderson
  1. Paediatric Respiratory Specialist Nurse, Wishaw General Hospital, Adams J, Healthcare Improvement Scotland, UK


Background The Scottish Patient Safety Programme for Paediatrics (SPSPP) has a medicines management workstream of which medicines reconciliation is a primary driver to reduce harm to children from medicines.1 The British Thoracic Society (BTS) local and national audit data on paediatric asthma has demonstrated poor discharge planning and education for children regarding inhaler technique, both of which can contribute to future readmissions.2

Objective To create a care pathway for the medicines management and education of patients with asthma or viral induced wheeze in line with national priorities and to assess effects on patient care.

Methods A baseline audit was undertaken to determine:

  • Current practice with regards to medicines reconciliation and use of patient's own drugs (PODs) within the ward.

  • Whether inhaler technique was demonstrated at the start of therapy.

  • The current rate and timeliness of provision of inhaler technique education provided by the paediatric nurses within the unit.

  • Correlation between inhaler technique and whether the patient's condition was managed within primary or secondary care.

A care pathway was devised and implemented using improvement methodology techniques, these included:

  • Development of a medicines reconciliation form and guidance on use.

  • Devision of a local training pack to improve the training of all paediatric nurses who were then able to provide consistent improved, health literacy to patients and/or their caregivers using the ‘teachback method’.

  • Introduction of a sticker on cardex to ensure inhaler technique provided and documented.

Results Baseline audit data included 31 patients. 48% of patients had an accurate medication history documented on admission. 29% of patients had brought in their own inhalers. 45% of admitted patients were on a steroid inhaler prior to admission. 62% of patients had inhaler therapy checked within 24 h of admission. 94% of caregivers stated that they had been shown how to administer inhalers at the start of therapy (range between 1 month and 5 years). This initial demonstration had been by a variety of care providers. 84% of patients had their condition managed by their general practitioner. Postintervention data collection currently underway.

Conclusion The baseline audit identified that medicines reconciliation was not being undertaken for patients. It highlighted areas of improvement for health literacy regarding inhaler administration and disparities of education provided by the nurses in the paediatric unit. Improvement methodology techniques require continual data collection and the real impact of the interventions made will only become apparent over time.3 The authors hope to see this through improved local BTS audit results, reduced admissions from poor control due to poor inhaler technique, less time spent on education by nurse specialist, use of PODs to aid drug history and reduced harm to patient with accurate medicines reconciliation, as well as a positive financial impact as a result of use of PODs.

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