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Why having a community children’s asthma service is so important

18th September 2017

The Children’s Asthma Team at Croydon writes about the ‘September Spike’ and the importance of prevention

September will be a busy time for our Children’s Asthma Team at Croydon Health Services NHS Trust in the lead up to the ‘September Spike’ (week 38); a well-documented phenomenon that sees a sharp increase in emergency hospital admissions for asthma.

The main culprit for the September Spike is the return to school, with subsequent exposure to bugs and viral illnesses and a lapse in preventer inhaler use over the school holidays. Going to bed late and getting up late means a change of routine and established asthma habits sometimes slip.

Our service was commissioned to reduce the number of asthma-related A&E and hospital admissions for children and young people by providing asthma care and education through home visits. Croydon Health Services NHS Trust has the highest number of emergency presentations for asthma and wheeze in children in London so we’ve had a lot to do!

Our role is one of prevention and health promotion; we do home visits to provide education to children and their families to help them confidently self-manage their asthma. As a one-off intervention, we have the luxury of spending a whole hour with children and their parents, which is something that busy GP’s, practice nurses and hospital clinicians don’t often have. You really get the best out of children in their own environment as they are more relaxed and receptive to the information we give them. Parents are often less stressed and tired too and it’s their opportunity to ask questions and discuss concerns.

We’re pretty tech-savvy in our team, as we’re aware of the importance of engaging with young people in age-appropriate and exciting ways. We use videos, web-based learning tools, social media and text messaging to deliver key asthma messages.

A typical visit involves developing a personalised asthma action plan in collaboration with children and their parents. This forms the basis of successful self-management as asthma plans guide children and their parents through the management of their asthma, and helps identify their triggers. We also share a child’s asthma plan with their GP, school and hospital consultant; promoting a seamless approach to asthma care and subsequently improved long term health outcomes.

We use Asthma UK’s child action plans, as they are simple to complete and use a traffic light system to guide children and parents on steps to take if their child’s symptoms worsen. They also enable identification of triggers which is a recommendation made in the National Review of Asthma Deaths (2014) and London Asthma Standards (2016).

We provide lots of education about asthma medications in the form of a medication review. Parental anxiety about daily inhaled steroid use is a common factor so having an hour to spend with parents and young people to talk about their fears can make the difference between taking essential medications and not.  To help our younger patients understand about their inhalers we designed the ‘Asthma Squad’; a team of super hero inhalers whose super powers help make children feel better. This makes it more relatable and of course lots of fun.

It’s also our job to ensure that our patients receive an inhaler technique check. Many children don’t use a spacer to take their inhalers, so there’s a lot of education to be done. Inhaler technique checks are often overlooked, but they are a fundamental part of asthma self-management and crucial for optimum asthma control.

Bridging the gap between primary and secondary care is also a crucial part of our role. We work closely with local GP’s and practice nurses to encourage referrals and we liaise with primary care professionals after our intervention. Working together in this way encourages an integrated, joined-up approach to asthma care and better health outcomes, especially for high-risk asthma patients.

We also work closely with Croydon University Hospital and spend time on the Children’s Inpatient Ward and Paediatric Emergency Department meeting new patients and offering ad-hoc training to staff.

Although we are not based at Croydon University Hospital we visit daily.

We act as a resource for local primary care health professionals and welcome them to contact our team for advice. Delivering regular asthma updates in different parts of the borough provides the opportunity to disseminate best practice, share ideas and discuss cases.

It also provides the opportunity to promote the London Asthma Standards. These standards were developed to bring together previous and existing standards and ensure consistent care for children and young people with asthma.

We also promote the London Asthma Toolkit to our primary and secondary care colleagues and to local schools. The toolkit was launched in 2016 by the Healthy London Partnership to support all professionals working with children and young people with asthma. It has a variety of useful information, resources and templates and is well worth reading and using.

As children and young people spend a significant part of their lives at school we also recognise the importance of collaborative working with local schools and PE teachers to improve asthma outcomes for school-age children and promote safe school asthma care.

We receive referrals from local schools and often carry out school visits which provide the opportunity to give consistent advice to children, their families and key teaching staff and ensure that children with asthma have an asthma plan and asthma medication at school.

Whole school staff training and the development of asthma school care plans remains under the remit of our local school nursing team as our input is provided only to children who are referred to us. However, we do offer support and advice to school nurses and of course value their role in identifying children with poor school attendance.

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