Asthma Friendly Schools Karen.Rodesano@nhs.net CYP LTC NURSE

Aims of the AFS project Reduce asthma attendances to ED, admissions to hospital and asthma related morbidity Reduce ‘nos. days off school’ Promote good asthma management for children and young people. Schools to achieve AFS standard. Pre AFS data available for ED attendance MTP for school nurses to keep a track of ED for asthma

BACKGROUND 1. 1million children in UK with asthma BACKGROUND 1.1million children in UK with asthma* 17 child deaths, 12 of which were in London last year Islington Schools 24,752 children attend Islington schools 61 mainstream, 5 special schools. 3000 CYP have asthma 12% * reference : Asthma UK So what does this tell us about London we have worst asthma care in the uk By getting basics right we can improve vastly on this

Pre AFS no schools had any standards for asthma in place Teachers had very little understanding of effective asthma management Five gold standards of asthma care as per NICE and BTS SIGN asthma guidance

AFS GOLD STANDARDS Asthma register Asthma policy Every child or young person with asthma to have an asthma care plan spacer and inhaler Every school to have an emergency procedure in place Every school to have an asthma lead References :BTS Asthma Guideline2016: NICE Quality Standards 2014:HLP Asthma Toolkit 2016. Hardly any care plans or spacers no emergency inhalers no asthma lead basic asthma care not provided and by basics care plan spacer and inhaler Support given to put standards into place Dedicated full time job for one nurse focus on AFS

Method Whole school teacher training Whole school assembly Coffee morning for parents Drop in sessions for young people Support with care plans asthma policy and emergency inhaler packs Pre and post teaching audit identified that staff had very little knowledge around basic asthma care Assembly taught children and young people about asthma and asthma management Coffee mornings taught parents about good practice a lot pf parents were not using spacers with MDI Drop in sessions taught young people about asthma management and gave them the tools to empower them to take control of their asthma i.E care plans spacers ACT

The process … The overall process is reflected in the 211 steps on the gantt chart – however by way of a precis the graphic help us see the step by step guide. Data base – now developed and shared with other staff – complete log of all Islington Schools with key contact and telephone number. Once we had this in place (and during its development) Schools were emailed ( template email) intorduction of AFS and the 5 standards required. Follow up phonecall…phonecalls!! Once you have spoken to the right person (Usually the SENco or deputy head) make an appointment to do an initial audit (lots of discoveries through the audit…best to take a pic of how schools store their meds, check expiry dates and if there are any spacers) You may think that you are now half way there – not so…. You will need to send the Action plan using the audit as your template and send to school with all the Paperwork – there is lots!!! It may be one of the reasons there has been a lack of follow through – At every step of the way support has been offered to make the changes – spend the day in the school helping to implement , very few took me up on the offer but many needed email or telephone support – one school called on a daily basis – this led me to do a step by step guide on what is required to become asthma friendly….more paperwork! Training – Training is what brings this all together….In the beginning I would not train a school unless the action plan had been completed. More recently however I have gone in to do the training before the AP is completed – it is interesting to see staff reactions when they realise they are not on top of the procedures and the worst case scenario for this. This is then a catalyst for getting it done – Even better if the HT attends!....Ideally all the training needs to go on a spreadsheet with a view to rebooking the following year at the same time…. Post training we have another audit then the certificate can be awarded if all actions completed. SEN Community workers Teachers Training admin Parents Support staff pupils

Emergency plan Emergency posters for school postcard size poster given to parents and students school care plan on reverse of postcard to go with spacer and inhaler

Care Plan When my inhaler(s) are running low, my parent/guardian or I will replace it/them. I have had an annual asthma review in the last 12 months. My parent/guardian gives consent for the use of emergency inhaler. If I need to use my reliever inhaler more than two times a week, please advise my parent/guardian so they can organise a review with my asthma nurse/GP. Added to care plan

AFS Summary 1 represents 66% of Islington Schools now AFS 2 represents 11% on pathway to be completed September 2017 3 represents 23% schools unable to commit to AFS Blue amount of schools complete AFS Orange on pathway Green non engaged

DATA Collection All school completed a pre AFS audit (63) 42 schools completed a post AFS audit 42 schools completed a pre-teaching evaluation 42 schools completed a post teaching evaluation 9 remain on pathway for completion next term 12 schools could not accommodate the project Plus we have ED data pre AFS and will be monitoring days off school using 2 schools to compare

Evaluation Measure results from before and after training Compare ED attendance before AFS and after Reduce morbidity School attendance ACT scores in school School nurses MTP notification of children presenting at ED and can recognise those attending for asthma Measure results of how asthma knowledge has improved from before and after training Recorded what each person found useful about the training look for trends and gaps in the knowledge of asthma i.e difference between different types of inhalers amount of mdi being used without a spacer therefore increasing asthma knowledge Measure school attendance before AFS and after

Reflections on project School/ building a relationship with health Relationship school nurses/ community/acute Enabling holistic health care pathway (key role GP etc) Empowering students, teachers, parents AFS Lead focused on project ( no distractions ) School attendance ACT (asthma morbidity) Variables measuring data ( ED attendances)

Any Questions ??

Whittington Health Magdala Avenue London N19 5NF 7272 Tel: Whittington Health Magdala Avenue London N19 5NF 7272 Tel: 020 3070 Fax: 020 7288 5550 Website: www.whittington.nhs.uk