With the ever-expanding role of general practice nurses (GPNs), alongside increased clinical scope and capacity, and increasing pressures of targets, it can be easy to simply ‘tick the boxes’ during an asthma review. However, an asthma review is not only to get an enhanced view of the child or young person’s asthma control in general, but also their individual perceptions, triggers, along with their own agenda or drivers (which may not be the same as the clinicians). By considering social, family or emotional influences, the review can answer crucial questions, such as, ‘Why has this child been to A&E again?’, ‘Why is this child getting through four reliever inhalers each month?’, or, ‘Why have these siblings missed their review again when one was so ill last year?’. This article explores how GPNs are well placed to educate patients and their families about asthma, to discuss inhaler technique, medication use and asthma triggers, as well as to ensure that children and families are aware of the importance of attending their next asthma review. It also discusses the use of tools in assessment and planning.
Celebrating 30 years of improving lives
Welcome to this issue of GPN. We are delighted to share the latest news in the world of Education for Health, especially at the start of this very special year — we are celebrating our 30th anniversary!
This is an important milestone in our charity’s history and one we are looking forward to celebrating in 2017. During the year we will thank those who have contributed to our success, reflect on our achievements and make ambitious plans for the future. We plan to mark our anniversary with a number of activities in May and June.
Toby Capstick highlights why healthcare professionals and patients need the new UK Inhaler Group standards.
Teaching correct inhaler technique has long been known to be key in the management of respiratory conditions; the British Thoracic Society (BTS) and Scottish Intercollegiate Guidelines Network asthma (BTS/SIGN, 2016) and National Institute for Health and Care Excellence chronic obstructive pulmonary disease (COPD) (NICE, 2010) guidelines give almost identical advice to healthcare professionals; namely, that inhalers should be prescribed only after patients have received training in the use of the device, and have demonstrated satisfactory technique, which is repeated regularly thereafter. This recommendation is emphasised in the NICE asthma and COPD quality standards (NICE, 2013; 2016).
Here, Chris Loveridge reflects on a patient story where the focus slipped away from the patient resulting in a failure of care.
As nurses, one of the first things we are taught is how to communicate with patients. It is also important to look out for clues that might help to assess their condition. For example, in patients with breathlessness this could mean:
The UK has one of the highest death rates from asthma in Europe (Global Asthma Network, 2014). Every day three people die from asthma, two-thirds of these deaths are preventable (Asthma UK, n.d.). Why asthma still kills: The National Review of Asthma Deaths. Confidential Enquiry Report (NRAD) was published in 2014 by the Royal College of Physicians (RCP). It is the largest worldwide study looking into why people die from asthma and the first to adopt a UK-wide focus. The NRAD identified that only a fifth of people with asthma are receiving all the basic elements of asthma care which could help them manage their asthma effectively and reduce their risk of experiencing an asthma attack. It provided valuable insights and clear practical recommendations which, if implemented, could improve care and reduce the number of asthma deaths (RCP 2014).
With so many new inhaled therapies available for treating asthma and chronic obstructive pulmonary disease (COPD), how does the busy healthcare professional make a prescribing decision which is safe and effective?
There are many components to consider when performing an annual asthma review. The Quality and Outcomes Framework (QOF) can help by prompting healthcare professionals to include such tasks as inhaler technique, peak flow and the Royal College of Physicians’ three questions (RCP3Q). However, these are only process measures. To perform a review adequately, it is important also to understand the more subtle aspects of asthma management in order to achieve the best outcomes for the patient. The ‘SIMPLES’ approach is one way in which this might be achieved (Ryan et al, 2013).
General practice nurses (GPNs) are well placed to ensure that patients with respiratory conditions receive high quality, safe, effective, evidence-based care. The National Review of Asthma Deaths (NRAD) (Royal College of Physicians [RCP], 2014) found that two out of three asthma deaths could have been prevented with better routine care. The key components of good asthma care, including the importance of correct inhaler technique, were highlighted by this landmark report. Poor inhaler technique is known to adversely impact upon control of respiratory disease and its symptoms. In 2013, the National Institute for Health and Care Excellence (NICE) published Asthma Quality Standards. However, NRAD found that despite the existence of such solid recommendations and guidance there were potentially avoidable factors related to the implementation of national guidelines in 46% of the deaths that were reviewed. Most recently, the Chronic Obstructive Pulmonary Disease (COPD) Quality Standard was added as an update to COPD guidance (NICE, 2016). Both documents include quality standards around inhaler technique.
Spirometry is very easy to do, and very easy to get wrong (Martin, 2010; personal communication). Not only is quality
assured spirometry dependent on the effort exerted by the patient, and the technical ability of the spirometer operator,
but also on the understanding of the results by the person interpreting them.
Interpretation of the results is essential if any meaningful decision is to be made about the patient’s care.
Success!