Download Paediatric asthma clinical pathways

National Paediatric Asthma Collaborative
PAEDIATRIC ASTHMA CARE PATHWAYS
IN HOSPITAL
Initial Emergency Care:
i. Initial assessment following ABCDE approach
ii. Recognition that child is seriously unwell
iii. Subsequent management based on BTS-SIGN Asthma Guidelines
iv. Ensure adequate dose systemic steroids given within 60 min (NICE Standard).
Further Care in Hospital:
i. Further treatment , observation and history as appropriate
ii. Structured review by member of specialist respiratory team before discharge (NICE Standard)
– including:
- Identify any exacerbating factor(s)
- Identify allergic co-morbidities (e.g. rhinitis)
- Check and modify inhaler technique
- Parental/ child asthma education
- Provide/ update Personal Management Plan
iii. Agree on-going management + arrange follow up
iv. Ensure adequate liaison with primary care – inc. arranging GP review within 2 working days
(NICE Standard)
Early Review/ Assessment/ Management:
i. Integrated respiratory, allergy and ENT focused history and examination
ii. Basic investigations (may depend on child’s age, available facilities etc but mainly on
clinical assessment) e.g. SPT/ sIgE/ PEFR/ spirometry etc)
iii. Establish and review definitive diagnosis
iv. Explanation, assessment and demonstration of device(s) technique
v. Trial and/or review of appropriate medication and delivery device(s)
vi. Risk assessment / trigger factor avoidance advice
vii. Management of co-morbidities
viii. Educate parents/ carers/ child and provide/ update written Personal Management
Plan
ix. Onward referral if appropriate
x. Communication with other relevant agencies (including consideration of
safeguarding issues)
xi. Signposting to patient support groups
xii. Ensure appropriate follow up arranged
Self care:
i. Recognition that child has lower +/- upper airway symptoms
ii. Knows how and when to administer reliever medicine (e.g. bronchodilator):
cf: http:www.medicinesfor children.org.uk/types-of-medicines/#!prettyPhoto
iii. Able to seek and access appropriate professional advice when needed
iv. Carries and follows Personal Management Plan, if available and indicated
Healthcare Professional (e.g. GP/ Practice Nurse/ School Nurse etc):
i. Awareness and recognition of typical patterns of asthma and co-morbidities at different stages
of childhood (including condition severity in accordance with BTS-SIGN Guidance)
ii. Able to treat as relevant to symptoms (including early administration of bronchodilator)
iii. Awareness of, and able to provide/ update, child’s Personal Management Plan
iv. Onward referral as appropriate following initial assessment and management
NRAD BASED RECOMMENDATIONS:
Arrange:
i. Review after every ED or OOH attendance with acute asthma
ii. Specialist respiratory review after every hospital admission with acute asthma
iii. Specialist respiratory review for all patient with ≥ 2 attendances to ED with acute asthma
within 12 months
iv. Specialist respiratory review for all patients requiring ≥ 2 courses of systemic steroids for
asthma within 12 months
v. Specialist respiratory review for all patients on BTS-SIGN Step 4-5 asthma severity
Ongoing Standard Management:
i. Regular structured medical review – minimum frequency annually (NICE Standard)
ii. Optimise prevention, recognition and management strategies of future
exacerbations
iii. Review/ modify inhaler/ spacer/ delivery device technique(s)
iv. Review and optimise treatments
v. Monitor growth (height/ weight centiles)
vi. Aim to minimise impact on QoL, inc. impact on school attendance and performance
vii. Revise/ update Personal Management Plan
viii. Recognise, minimise and treat any complications of long term use of medications
ix. Recognise, minimise and treat any emerging allergic co-morbidities
x. Communication with other relevant agencies (including school/ education liaison)
xi. Access psychosocial support if appropriate
xii. Appropriate planning for and management of transitional care
xiii. Work towards supported independence
TERTIARY +/- SECONDARY SPECIALIST CARE
Paramedics/ Primary Care/ Walk In Centre:
i. Initial assessment following ABCDE approach
ii. Recognition that child is seriously unwell
iii. Early administration of oxygen + bronchodilator:
- mild to moderate: pMDI + spacer preferred
- severe/ life threatening: nebuliser preferred; ensure adequate dose systemic steroids
given within 60 min (NICE Standard).
iv. Consider transfer to hospital ED
v. Ensure adequate liaison with primary care – inc. arranging GP review within 2 working days
(NICE Standard)
NOT ACUTELY UNWELL
RECOGNISE AND TREAT POSSIBLE ANAPHYLAXIS WITH I.M. ADRENALINE IF AVAILABLE
Self care/ Public places/ Pharmacy/ Schools:
i. Recognition that child may be seriously unwell and early call for help
ii. Administration of a bronchodilator – if available and indicated
iii. Follow Personal Management Plan, if available and indicated
iv. Consider calling 999
PRIMARY/ SECONDARY/ TERTIARY CARE as appropriate
ONGOING MANAGEMENT
INITIAL RECOGNITION
OUTSIDE HOSPITAL
ACUTE ASTHMA
Difficult/ Complex Asthma Management:
i. Regular structured medical MDT review
ii. Review diagnosis and manage co-morbidities
iii. Specialised investigations (e.g. eNO,
bronchoscopy, induced sputum, imaging, nurse led
home visit etc)
iv. Review and optimise treatments inc.
immunomodulatory therapies
v. Communicate with other agencies (inc. other
healthcare professionals, social care for safeguarding
etc)
vi. Access to clinical psychology
xii. Appropriate planning for and management of
transitional care
Paediatric Asthma Care Pathways v1.0 January 2015