l asthma nnovation in quality improvement of care in children Dr. Sabina Shaik GP – Redwood House Surgery Slough CCG Lead – Paediatrics SLOUGH Clinical Commissioning Group

Asthma admissions has been a national problem Asthma admissions has been a national problem.As you all can see from the graph Slough has been high in asthma emergency admissions compared to our neighbouring CCGs.1 in 10 children presented to A&E with a wheeze.

Tipping Point – 2 child deaths in January 2014 9 yrs old Girl 12.01.14: 0200 11 yrs old boy 26.01.14: 1330 onset “bad chest” 72 hrs Sudden on exercise meds Fluticasone;salb. Becotide;salb. Family History of Asthma Parents & 2 siblings - Last Asthma review May 2012(First & last rv) Sep 2013 DNA’s Aug 2012- Asthma Clinic Jan 2013- Flu jab June 2013- Asthma clinic Last s/b GP or Nurse October 2013 3rd January 2014

No individual concerns CDOP REVIEW No individual concerns CCG to consider overall assessment and review the process of Asthma care in Slough VERITA Independent Management Consultancy Capture Key learning and improve clinical Practice Led by Prof Mike Pringle 14 recommendations Review recommendation 1: Standardised template to be developed to ensure clinicians are covering important aspects of asthma care beyond QOF e.g. parents smoking, school, inhaler technique observed ,asthma management plan Action: Template will be developed by the clinical working group and tested out with practices by Dec with a presentation at STEPS by Jan/ Feb

CCG - Asthma diploma module 2 Asthma Coded diagnosis Practices should record asthma as a coded diagnosis as soon as practicable, and not allow the QOF to influence this clinical judgement 1 7 First asthma reviews performed early in the illness .Patients stepped up/ down should be reviewed between four to six weeks later , CCG - Asthma diploma module 2 Asthma Coded diagnosis 1 3 Regular and opportunistic reviews performed by appropriately trained doctor or nurse. should be comprehensive, extending beyond QOF indicators 6 First review Step up/step down Up to date PAAP 4 Length of review consultation (where the minimum is 20 minutes and a first review is 30 minutes). Possibly utilising flexible PMCF appointments 2 5 An asthma ‘refresher’ STEPS session on the principles of good electronic record-keeping for ALL Primary Care staff. This includes asthma care, utilisation of correct read codes and recording of asthma action plans , 5 Asthma ‘refresher’ STEPS session Regular and opportunistic reviews First asthma reviews performed early in the illness Patients stepped up/ down should be reviewed between four to six weeks later Regular and opportunistic reviews performed by appropriately trained doctor or nurse should be comprehensive, extending beyond QOF indicators. length of review consultation (where the minimum is 20 minutes and a first review is 30 minutes). Possibly utilising flexible PMCF appointments An asthma ‘refresher’ STEPS session on the principles of good electronic record-keeping for ALL Primary Care staff. This includes asthma care, utilisation of correct read codes and recording of asthma action plans Review processes for recording and the risk assessment of asthma triggers; with parents given the up-to-date asthma action plan to follow. The CCG should consider sponsoring an asthma diploma module, to upskill practice nurse skill mix Length of review consultation 6 Record changes to the steps of treatment and parents given the up-to-date asthma action plan to follow. 3 4 7 CCG should consider sponsoring an asthma diploma module, to upskill practice nurse skill mix

Vision for Asthma care for Children in Slough Diagnosis Reducing hospital admissions and Preventing deaths from Asthma Comprehensive Review Quality of Life Early and accurate diagnosis of Asthma Regular structured and comprehensive review-ASTHMA MANAGEMENT PLAN Improved access to services when symptomatic Able to lead lives free from asthma symptoms Access to services

A S T H M A Asthma Working Group Secondary care, Schools, Surgeries AIM and Purpose A Improve Asthma Care S Secondary care, Schools, Surgeries Focus Group T Training & Teaching H Reducing Hospital attendances A – improve Asthma Care S - Schools, school nurses, Surgeries, Secondary Care Consultants T - Training, Teaching, H - reducing Hospital attendances & admissions M - Managing patients effectively and safely in the Community A -Awareness in Public M Managing Patients effectively & safely in the Community A Awareness in Public

2015 Practice Visits

2015 Asthma Template Practice Visits

2015 Video Link & Puffell Asthma Template Practice Visits

Asthma Pathways Video Link & Puffell Asthma Template Practice Visits 2015 Asthma Pathways Video Link & Puffell Asthma Template Practice Visits

Education & Training Asthma Pathways Video Link & Puffell 2015 Education & Training Asthma Pathways Video Link & Puffell Asthma Template Practice Visits

Education & Training Asthma Pathways Video Link & Puffell 2015 Community Asthma Nurses Community Asthma Nurses Education & Training Work across primary and secondary care Reduce paediatric asthma admissions Perform patient review before hospital discharge Post discharge follow up Nurse led clinics in Community & Hospital Provide training and education to Practice and School nurses Provide support for parents Telephone follow up and advice to parents Asthma Pathways Video Link & Puffell Asthma Template Practice Visits

Inaugural on 19th Sept 2016 School Visit UK’s First Asthma BUS

NHS Slough CCG Non-Elective Paediatric Average Length of Stay Conclusions -Systematic primary care response to deaths from high prevalence/low mortality disease -Measurable effect on non-fatal outcomes -Service improvements from death reviews -Sustainability and roll-out from pilot? NHS Slough CCG Non-Elective Paediatric Average Length of Stay

THANK YOU Any questions? Dr. Sabina Shaik Vision for Asthma Care for Children in Slough http://tinyurl.com/zo2cx6t Any questions? THANK YOU Dr. Sabina Shaik GP, Slough CCG Lead - Paediatrics sabinashaik@nhs.net SLOUGH Clinical Commissioning Group