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172 Discharge management of children under 5 with suspected asthma in a UK hospital

BMJ paediatrics open, 2021-04, Vol.5 (Suppl 1), p.A48-A49 [Peer Reviewed Journal]

Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ. ;2021 Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ. ;EISSN: 2399-9772 ;DOI: 10.1136/bmjpo-2021-RCPCH.94

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  • Title:
    172 Discharge management of children under 5 with suspected asthma in a UK hospital
  • Author: Ford, Charlotte ; Nyamugunduru, Godfrey ; Woolf, Sarah
  • Subjects: Asthma ; Audits ; Inhalers ; Pediatrics ; Steroids
  • Is Part Of: BMJ paediatrics open, 2021-04, Vol.5 (Suppl 1), p.A48-A49
  • Description: BackgroundThe British Thoracic Society (BTS) recommends that children under 5 years of age who are admitted with suspected asthma should be discharged as per the BTS Asthma Discharge Care Bundle since this improves patient outcomes1. Many children with suspected asthma are prescribed inhaled corticosteroids (ICS) to reduce airway inflammation2. We suspected substandard discharge care of children under 5 hence decided to audit our practice.ObjectivesTo assess compliance with the BTS asthma discharge bundle, for children under 5 admitted with suspected asthma, who were discharged on inhaled corticosteroids.To improve and standardise the discharge planning of this group of children.MethodsChildren with a discharge diagnosis of viral induced wheeze (VIW) or asthma, between 01/12/2018 and 31/11/2019, were provided by the hospital information department. Patient notes on iSOFT electronic patient record system were reviewed and those discharged on ICS were identified. From these, every other case in ‘date of admission order’ was selected and audited against the BTS bundle. This retrospective audit was approved by the trust.ResultsOut of a total of 447 children discharged with VIW or asthma under the age of five, 123 patients were discharged on ICS and of these 62 were randomly selected for audit.Abstract 172 Table 1 BTS discharge care standards Compliance (n =62 ) Community follow up within two days 13 (21%) Importance of adherence to preventer medication discussed. 19 (31%) Triggers considered- including smoke exposure. 24 (39%) Specialist care follow up in a month. 27 (44%) Inhaler technique assessed. 32 (52%) Consultant appointment in 2–3 months. 41 (66%) Inhaler use instruction provided. 50 (81%) Medications reviewed prior to discharge. 55 (89%) Written action plan provided. 59 (95%) Only 9/62 (15%) patient records were 100% compliant with the BTS bundle. 22/62 (35%) were less than 50% compliant. 17/62 (27%) did not have any follow up (neither hospital nor community).ConclusionsThe BTS discharge standards for children under 5 years with suspected asthma were not followed in the majority of children. The lack of follow up of many children who were discharged on ICS is particularly concerning, potentially sentencing them to long term ICS and consequent risk of side effects.We recommend that shortfalls identified by this audit be addressed followed by re-audit after a year.ReferencesBritish Thoracic Society. Improving Outcomes in Asthma- Asthma Care bundle. [Online] 22/4/2016. https://www.brit-thoracic.org.uk/quality-improvement/clinical-resources/asthma/Price, John. The role of inhaled corticosteroids in children with asthma. BMJ. (2000), Vol. 82,2.
  • Publisher: London: BMJ Publishing Group LTD
  • Language: English
  • Identifier: EISSN: 2399-9772
    DOI: 10.1136/bmjpo-2021-RCPCH.94
  • Source: BMJ Journals (Open Access)
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