High-risk reviews and mentoring pharmacy support to improve care for children and young people with asthma in North West London
Following on from two tragic and preventable deaths in North West London (NWL), the Children and Young People’s (CYP) Asthma Network is keen to support all clinicians who interact with CYP asthma.
Darush Attar-Zadeh is an independent pharmacist and Alison Summerfield is a Paediatric Nurse Consultant working with the NWL CYP asthma network on a project to reduce asthma admissions and support people to live better with asthma.
The project involves supporting pharmacy teams, nurses, GPs and other colleagues in Primary Care Networks (PCNs) through:
- Developing systems to recognise and manage CYP who are at high risk of asthma exacerbations through optimised medicines management
- Mentoring experienced pharmacists over 6 weeks to effectively and confidently run an asthma review in CYP.
Alison and one of her colleagues go directly to GP practices to work jointly with pharmacists over 6 weeks. Their style of delivery is to first teach asthma consultations with CYP and their parents/guardians following a structured model. Then the empowered pharmacist runs a session following the same model whilst being supervised and provided with constructive feedback.
Darush delivers at least 3 sessions (3 hours total) of support with the option of group consultations and weekly consolidation session attendance to bolster knowledge.
The sessions support pharmacists/pharmacy technicians mainly across two levels:
Searches, audits, influence IT systems to ensure safe ordering and labelling of short-acting beta-agonists (SABA), starting conversations with young patients to help address common myths around SABA and inhaled corticosteroid (ICS) use in asthma
Pharmacists with more experience in running asthma reviews to help support CYP asthma and parents/guardians on addressing SABA over-reliance, ICS underuse and co-creation of personalised asthma action plans.
The skills and knowledge taught from these sessions will be applicable to all ages. Simple to understand metaphors are practiced and competencies from the National CYP asthma bundle are followed.
Does this work for explaining when to use relievers and preventers for asthma?
“You have a leak in your house. You can do one of two things: use a bucket or call a plumber.”
What metaphors do you use?
Working towards competencies from the National CYP asthma bundle:
- Capability 1: Asthma awareness:
- LO1: Have a basic understanding of ‘What is asthma?’
- LO2: Have a basic understanding of why is it a problem?
- LO3: Understand how common it is and its potential impact/seriousness
- LO1: Is able to demonstrate basic knowledge of the aims of asthma treatment and the broad principles of achieving it
- LO1: Is able to demonstrate understanding that it is everyone’s responsibility if a child’s asthma control is inadequate
- LO2: Is able to demonstrate the ability to recognise signs of poorly controlled asthma (cough, wheeze, overuse of reliever inhalers, school absence, sleep disturbance) and the dangers of over-reliance on SABAs
The training was specifically targeted at high SABA prescribing practices. Information gleaned from the Business Service Authority EPACT 2 database is already showing early indications of safer prescribing patterns in a few of the boroughs.
Preliminary results indicate that all of the practices on the most improved list have undertaken training compared to 51% (19/37) from the practices that show the least improvement (open prescribing data).
Approximately 60% of the practice improvements are seen soon after training/MDT work (but the authors note that this could of course be linked to other factors as well).