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

2. 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

3. BACKGROUND 1. 1million children in UK with asthma
BACKGROUND million 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 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

4. 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

5. 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

6. 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

7. 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 ed ( template ) 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 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

8. 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

9. 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

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

11. 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

12. 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

13. 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)

14. Any Questions ??

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