1. 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

2. 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.

3. Tipping Point – 2 child deaths in January 2014
9 yrs old Girl
: 0200
11 yrs old boy
: 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 Asthma Clinic
Jan Flu jab
June Asthma clinic
Last s/b GP or Nurse
October 2013
3rd January 2014

4. 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

5. 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

6. 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

7. 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

8. 2015
Practice Visits

9. 2015
Asthma Template
Practice Visits

10. 2015
Video Link & Puffell
Asthma Template
Practice Visits

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

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

13. 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

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

15. 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

16. THANK YOU Any questions? Dr. Sabina Shaik
Vision for Asthma Care for Children in Slough
Any questions?
THANK
YOU
Dr. Sabina Shaik
GP, Slough CCG Lead - Paediatrics
SLOUGH
Clinical Commissioning Group