Abstract
Background: National guidelines advocate use of specialist nurses in managing patients with asthma. However, there is uncertainty about overall impact upon improving patient care[1]. We compared acute management of patients with asthma exacerbations in 2 district general hospitals, 1 with (H1) and 1 without (H2) asthma nurses to see if there were differences in adherence to national guidelines.
Methods: We retrospectively reviewed case notes of patients admitted/seen in A&E in 2 hospital trusts with an acute asthma exacerbation over 4 weeks (September 2014). Data collected included asthma nurse/respiratory team reviews and if recommended interventions (inhaler technique, appropriate discharge advice and action plan) were undertaken.
Results: In H1 25 patients were seen, 9 admitted (36%). In H2, 87 patients were seen, 22 admitted (25%). In both hospitals no patients were reviewed by asthma nurses in A&E. Of admissions, 44% of admissions were reviewed by asthma nurses in H1 (all on respiratory wards). 55% had specialist respiratory input in H1 vs 23% (H2). 77% of H1 patients had asthma plans documented vs 45% (H2). GPs were informed within 24hrs of discharge in 66% (H1) vs 13.6% (H2) and 55% were advised to see their GP within 48hrs (H1) vs 36% (H2).
Conclusion: Asthma specialist nurses do improve adherence to asthma guidelines compared to a trust without this service. However, adherence is still not 100%, likely due to patients not being referred for specialist input as per national guidance. More work needs to be done to improve pathways so all asthma patients are captured.
[1] Griffiths C et al BMJ 2004;328:144-147.
- Copyright ©ERS 2015
