How well have the recommendations for NRAD been implemented in Dumfries and Galloway? Dr Fergus Donachie GP lead for Respiratory Managed Clinical Network Dumfries and Galloway

Background Dumfries and Galloway has population 150,000 Served by one District General Hospital 35 GP practices

National Review of Asthma Deaths Detailed review of all asthma deaths in one year Showed care was poor Suggested many of the deaths were potentially preventable Made a series of recommendations to improve practice

How to implement this? Educational meeting Letter to GPs and Practice nurses Respiratory discharge bundle Prescribing advisors

Survey of Practices Self reported Based on the NRAD recommendations 60% response rate

Everyone Had a practice asthma lead Actively chased non-attenders Carried out an annual asthma review as per guidelines Had a system to see acutely ill asthmatics quickly Had the appropriate equipment and training to deal with acute asthma Actively identified those at high risk (Lots of blue inhalers) Used a standardised review template

Room for Improvement 85% of nurses doing reviews had a recognised asthma qualification 60% reviewed asthmatic patients within 48 hours of discharge 38% of patients had an asthma action plan

Further Interventions Redesign and distribute simple asthma action plans to practices Post discharge follow up by secondary care – phone or face to face Offer to subsidise practice nurse training

Questions?