Asthma admissions rise

Nurses aren't given proper training, writes Gareth Hughes

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Hospital admission rates for asthma are higher in the North West than anywhere else in the UK, according to recent statistics from NHS Comparator.

Admissions in the North West are 23.1 per cent higher than the national average, while Yorkshire and Humber has the second highest rate, 19 per cent above the national average.

Within the North West, Knowsley fared worst with asthma admission rates 119 per cent higher than expected.

Ten years ago, University Hospital Aintree Liverpool conducted a study to investigate whether NHS staff were trained to deal with asthma patients.

No inroads

Following the study, the doctors who led the investigation recommended that improvements be made to asthma care to help reduce admissions.

However, a repeat study by UHAL this year has found that virtually no inroads have been made into improving asthma training for nurses.

Only 63 per cent of nurses were properly trained in asthma care, and 53 per cent said they didn’t have time to write personalised asthma plans for their patients.

Lack of training

Robert Angus, a UHAL consultant who helped conduct the study, said: “We thought this was quite poor – 37 per cent of people don’t have qualifications in asthma but they’re still running asthma clinics.

“Patients are running into trouble because the people who deliver primary care are not allowed to skill up to do it.”
Angus said the lack of training was not a budgetary issue. In fact better training could save money by reducing the need for admissions.

“I think sometimes nurses don’t like to take time off to do training because it costs money to practices but it’s a very modest funding issue,” he said.

“Over the last 18 months we have put a lot of work into asthma training for our staff,” said a spokesperson for NHS Knowsley. “A competent and skilled workforce is an area that we place high value on within NHS Knowsley and we have taken steps to ensure that our staff have access to the best training possible.”

When given personally written asthma action plans, patients often handle the condition well themselves. If all nurses gave their patients plans, experts believe the positive impact on admissions could be immediate.

“There is over a decade of clear evidence that personal asthma action plans help reduce admissions and we need to ensure that, irrespective of where someone with asthma lives, they are offered a plan,” said Neil Churchill, chief executive of charitable foundation Asthma UK.

Effective treatment

“It’s only once in your patient career that you need to be taught enough to handle it yourself,” agreed Angus. “It is easily solvable. There’s so much to gain here.”

Angus added that another barrier to effective treatment of asthma was the over-prescription of reliever medication compared with preventer medication. Relievers, usually inhalers, help to alleviate asthma attacks when they happen, whereas preventers are pre-emptive medicines designed to stop them happening at all.

Reliever medication

“From prescribing data, areas where admissions are high have a lot of use of reliever medicines,” said Angus. “They can save your life, but they don’t treat the condition.”

However, NHS Knowsley maintained that guidelines recommend using reliever medication at first and only employing preventers if the patient’s condition worsened.

“The use of reliever inhalers should always be the first step in treatment and patients should be stepped up as appropriate,” its spokesperson said.

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