Children s Asthma Services in Yorkshire and the Humber a local audit

1. Children�s Asthma Services in Yorkshire and the Humbera local audit

2. Audit of current asthma specialist nurse service in Yorkshire and Humberside Margaret Graham Children�s Asthma Nurse Specialist, Leeds

3. Aim of audit Audit against BTS guidance to evaluate: 1.Current paediatric asthma specialist nursing service provided 2.Levels of activity and services provided Assess current professional opinion on good and less good aspects of their service 18 centres contacted-all responded.

4. Audit and evaluation of care Asthma specialist nurse education of adults and school age children at, or shortly after, hospital attendance: improves control, self-management and re-attendance rates. associated with a reduced risk of further exacerbations. Audit the percentage of inpatients receiving care from asthma nurse specialist or chest physician Audit the percentage receiving specialist nurse advice�..before discharge. British Guidelines on the Management of Asthma. A national clinical guideline. May 2008 :pg 79

5. Nurse Specialists(CNS) In total 11.3 whole time equivalent CNS Some sisters/ staff nurses with special interest in asthma

6. Discharge Acute asthma attacks should be regarded as a failure of preventative therapy, and thought should be given about how to help families avoid further episodes. Discharge plans should address the following: Inhaler technique Need for regular inhaled steroids Provide a written action plan with clear instructions. Arrange follow up by a GP within one week Discharge from hospital or the emergency department, should be a planned, supervised event which includes self management planning. Arrange follow up in a paediatric asthma clinic within one to two months. British Guidelines on the Management of Asthma. A national clinical guideline. May 2008 :pg65

7. Care provided

8. Clinical guidelines Clinicians in primary and secondary care should treat asthma according to recommended guidelines Audit the percentage of patients treated according to key guideline recommendations British Guidelines on the Management of Asthma. A national clinical guideline. May 2008: pg 79 Glasgow audit 3 (17%) staff aware of it being undertaken this year Evaluating care 6 (33%) 2 Planning

9. Paediatric Asthma Admissions 2006-07

10. ? Good aspects of service Service CNS offer Training given to secondary and primary care staff Good team work and quality of care working to guidelines Resource for other professionals Developing asthma clinics Community team input

11. IMPROVEMENTS

12. Conclusion Inequality of service offered Need for improvement perceived Examples of innovative good practice Many enthused, committed staff keen to take the service forward

13. Title for Mary�s part

14. People who do not have a written personal asthma action plan are four times more likely to have an asthma attack requiring hospital treatment than those with a plan. Three-quarters of all children with asthma do not have a written personal asthma action plan.

22. Child wellbeing index (CWI) The Concept of Child Well-Being This an index of child well-being rather than an index of deprivation, mainly because it contains variables that are not strictly related to deprivation. Child well-being is generally represented by how children are doing in a number of different domains of their life. At national and international level these domains have included those covered in the CWI. This index covers the major domains of a child�s life that have an impact on child well-being. A scaling factor has been applied to housing and environment scores to make the chart easier to read.The Concept of Child Well-Being This an index of child well-being rather than an index of deprivation, mainly because it contains variables that are not strictly related to deprivation. Child well-being is generally represented by how children are doing in a number of different domains of their life. At national and international level these domains have included those covered in the CWI. This index covers the major domains of a child�s life that have an impact on child well-being. A scaling factor has been applied to housing and environment scores to make the chart easier to read.

23. What data do we need? Number and distribution by PCT of current, reviewed personal asthma action plans; Number of schools achieving the national healthy schools standards at level 3; Number and location of community based specialist asthma services; Number of emergency hospital admissions for asthma; PCT investment in training as a proportion of per capita spend; Number of paediatric beds and admissions Number of A&E attendances.

24. How do we get the data? National data sources eg: ONS, HES online, the Child and Maternal Health Observatory, Yorkshire & Humber Public Health Observatory, Association of Public Health Observatories, Healthy Schools; Local regional surveys Regional data capture and analysis function;