This improvement story focusses on the management of Asthma in the Camden School Nursing Service. Sally Lydamore and colleagues produced an excellent QI poster that received the Best Poster Award in the Safety Conversation 2022.
Safe Asthma Management for Camden Children Through Effective School Nursing Interventions
We know that poorly controlled and unmanaged asthma can result in a dangerous medical emergency with a high risk of death, children missing school, and can have an impact on their growth and development. Asthma is the most prevalent long-term medical condition affecting children and young people in the UK. It is estimated that it will affect 5,300 children in Camden by 2025. In Camden, stakeholders across the borough have produced a local strategy to operationalise and take forward some core priorities for asthmatic children - in line with the North Central London Partnership recommendations. School Nurses have a key role in supporting schools, families and children in the safe management of asthma and in supporting the Asthma Strategy.
Our improvement project set out with the following aims:
- For all Camden schools to be asthma friendly by 2023 (reducing stigma, promoting safe management, and community ownership)
- To keep children medically safe in school
- To reduce hospital admissions due to exacerbation of asthma
- For all children on our caseload to have a “My Asthma” care plan
We launched our project in January 2020 for School Nurses and GP’s to highlight vulnerable families through meetings. Link Nurses spoke to schools about the Asthma Standards promoting the “Ask Me About Asthma” Campaign as part of the partnership agreements.
Our methodology was driven by school Nurses, who identified asthmatic children, and offered all a health review and care plan. In doing this, the school nurses were able to ensure that medication to treat asthma was managed correctly in the school environment and that staff were appropriately trained. It was also important that School Nurses provided follow up support in school following hospital admissions and unscheduled Accident & Emergency (A&E) presentations and were able to facilitate safe school transfers. We felt that it was vital that we were able to promote children/young people’s autonomy in managing their medical condition.
We then collated and analysed data collected by Link Nurses and School Nursing Staff on SystmOne and this was used to inform service leads how effectively care was being provided. The service measured the numbers of clinical interventions and used data to analyse outcomes.
In parallel with our data analysis, we undertook a school feedback survey at the end of the academic year, asking school senior leadership team members to evaluate the service.
What we found was that the project had significant impact on the engagement of children in our service alongside a marked decrease in the numbers requiring an attendance at an A&E department:
- From the 612 children requiring initial intervention, 600 required 4-6 weekly follow up
- School Nurses have had a 75% increase in clinical activity managing medical conditions in schools from the previous year
- A&E attendances were reduced from 71 to 14 throughout 2020/2021
Lessons Learnt
The number of A&E admissions for exacerbation of asthma have reduced due to collaborative working, which is key to managing medical conditions.
Schools value the role of the School Nurse in supporting them to keep children with medical conditions such as asthma safe in school.
The profile of the School Nursing Service has been significantly raised with Camden GP’s and the partnership working around children's health needs has improved.
Effective partnership working between School Nurses and the Camden Asthma and Atopy (Asthma & Eczema Clinic) Nurse has provided a more accessible service for hard to reach families, keeping them safe.
Utilising the materials provided by the “Ask Me About Asthma” Campaign enables School Nurses to deliver public health promotion on asthma and deliver safety messages.
If you would like to know more specific details about this project then please see this team’s poster submission to the CNWL Safety Conversation Day 2021 on Trustnet or email us at cnw-tr.improvementsupport@nhs.net and we will be very happy to connect you with someone from the Camden School Nursing Service.