1. THE USE OF A WRITTEN ASTHMA ACTION PLAN IN PATIENTS DISCHARGED FROM THE EMERGENCY DEPARTMENT OF THE MATER MISERICORDIAE UNIVERSITY HOSPITAL
Dr. Nafisah Borhan, Dr. Padraig Hawkins, Olivia Lee, Dr .Dermot O’Callaghan, Dr Adrian Moughty
Department of Emergency Medicine, Mater Misericordiae University Hospital, Dublin.
Department of Respiratory Medicine ,Mater Misericordiae University Hospital, Dublin.
INTRODUCTION & AIM
Asthma is a common condition with 14% of asthmatics availing of emergency services in Ireland nationally amounting to 4753 admissions and over 50 deaths per year1. Most deaths occur before admission to hospital2 . It has long been recognised that a written asthma action plan helps patients to recognise and respond appropriately to worsening asthma and speciality guidelines reflect this3,4. An audit was performed to qualify adherence to guidelines in the Emergency Department for patients presenting with an acute exacerbation of asthma. The focus was on the use of a written asthma action plan in this population .This could be viewed as an opportunity to educate patients and provide them with a written asthma action plan on discharge from the Emergency Department.
METHODS
CONCLUSION
A retrospective audit was performed on all emergency presentations to our institution over a 5 month period from January to May 2015 with an exacerbation of asthma. Patients Emergency Department electronic records, written clinical notes, respiratory treatment protocol and discharge letter were reviewed and patients were interviewed by phone regarding provision of a written asthma action plan before and after presentation to Emergency Department. The Mater Hospital Respiratory protocol is a printed document used for the assessment, management and discharge planning of patients seen in the Emergency department with an asthma exacerbation (Fig1). It is specific to this hospital but was developed based on international guidelines and standards3, 4.
Vast majority (23/27, 85%) of patients presenting to the Emergency Department of the hospital do not have an asthma action plan. In light of this a more focussed pathway for follow up planning of patients discharged from the Emergency Department is being formulated. The aim of this quality improvement initiative is to improve patient care, the patient experience and to facilitate compliance with National guidelines.
RESULTS
REFERENCES
A total of 33 patients were identified as presenting with an exacerbation of asthma. 27 female and 6 male patients. The mean age was 39.6 years with a range of years. 6 patients were not contactable by telephone. None of the patient’s had the discharge portion of the respiratory protocol completed by the ED Physicians(Fig 1).19 patients had a discharge letter to their General Practitioner. Of those patients contacted, only (4/27, 15%) had a written asthma action plan, with only one of these being from the ED (3 had the action plan from their GP prior to their presentation to the Emergency Department).
Lung disease in Ireland-Prevalence & trends: Implications for workforce planning Dec 2013.
Irish Thoracic Society. Acute Asthma Management Guidelines.
BTS/SIGN British Guideline on the Management of Asthma. October 2014.
Global Initiative for Asthma Report, Global Strategy
for Asthma Management & Prevention April 2015.
Fig 1.