7. Limiting repeat SABA prescribing
System changes can be made to prevent lots of SABA inhalers being prescribed without a review from a health professional. One option is to take salbutamol off repeat prescribing. Practices who do this may choose to issue two SABA inhalers at annual review. Two SABA inhalers will meet most patient needs if their asthma is well controlled. This can be explained to patients at their asthma review.
Alternatively, if you wish to keep SABA on repeat, in SystmOne, you can edit the template prescription for SABA inhalers so that the default issue duration is longer than 28 days; for example 84 or 90 days or 180 days. You may also wish to tick maximum issues. You can choose a maximum of 2, which corresponds with evidence on SABA over-reliance, or a maximum of 5, to prevent patients receiving 6 or more SABA a year in the first instance. These changes allow the medical record to flag SABA over-reliance if patients are requesting inhalers frequently. We recommend that prior to enacting this change, you send all patients with asthma on a SABA inhaler, a bulk message to explain that they will not be able to receive more than a certain number of SABA inhalers without a review from a healthcare professional. See example SMS message below.
How this project works will depend on your practice systems for managing prescription requests. For safety reasons, your system should not result in inhaler requests being denied. You may wish to recheck default settings after IT system upgrades.
Edit prescription template (SystmOne only)
Edit the prescription templates for all SABA inhalers to adjust the prescribing interval or maximum number of issues.
To limit issues of SABA to fewer than 3 SABA inhalers per year (optimum) an issue duration of 168 or 180 days can be set. For fewer than 6 SABA inhalers a year an issue duration of 84 or 90 days can be set.
It may also be useful to set a maximum number of issues.
- IT guide on editing prescription template
- PCIT guide on editing prescription template in SystmOne (prescribing interval and max issues)
SMS message to patients on limiting SABA prescriptions
If you need to use 3 or more reliever (blue) inhalers a year, this more than doubles your risk of an asthma attack. To ensure we identify patients whose asthma control needs improvement, our systems will no longer allow patients to receive more than 5 rescue (blue) inhalers a year without a check from a healthcare professional. For more information have a look at this video or read this leaflet.