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Coding and Follow up of Asthma Exacerbations

This project is likely to take:
<10-20 hours for the initial project (excluding re-audit)
<20-40 hours in total (including re-audit)

Can be done by a GP, Nurse, Pharmacist, Admin lead, GP trainee or Student

Green Impact for Health Toolkit area: Prescribing & Quality Improvement

CQC Areas

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The benefits of this project

Project benefits for Your Patients

Benefits for Your Patients

  • Reduces risk of asthma attacks and deaths
  • Reduces health inequalities as poorly controlled asthma more common in disadvantaged communities.
Project benefits for Your Practice

Benefits for Your Practice

  • Reduces workload by reducing unscheduled care related to poorly controlled asthma
  • Costs of poorly controlled asthma estimated as 52% higher that well controlled asthma
Project benefits for The Planet

Benefits for The Planet

  • Well controlled asthma has 1/3rd of the carbon footprint of poorly controlled asthma

Opportunity for improvement

  • The UK has one of the worst death rates from asthma in Europe, and this has not improved since the publication of the National Review of Asthma deaths in 2014.
  • The National Review of Asthma deaths 2014 showed that being admitted to hospital for asthma, or having to go to accident and emergency because of an asthma attack, were risk factors for future asthma attacks that may be fatal. They recommended contact with a GP within 48 hours of discharge to have medicines reviewed, asthma action plan updated and inhaler technique checked.
  • Letters from out of hours and hospital admissions must be coded correctly as 'asthma exacerbation' in order to identify patients who need immediate review and also for future risk stratification (see project identifying poorly controlled asthma)
  • You may wish to set yourself a SMART goal of having an agreed process of coding and follow up of asthma exacerbation within 3 months.
  • (see disclaimers)

How to carry out this project.

  1. Identify the process for adding clinical codes

    How are codes added from scanned hospital letters added in your practice? Whose job is this? Admin staff, clinicians?

    Identify if coding is being done correctly
    How are hospital letters which may indicate an asthma exacerbation currently coded?
    • Is an asthma exacerbation code used?
    • If patients receive a course of oral prednisolone, is this logged into the record?

    If a patient attends general practice with an asthma exacerbation how is this coded in the notes?

    You may wish to audit the notes of asthma patients known to have recent exacerbations to understand more about the process in your practice and if there is variation between the practice team.

  2. Training for staff

    If coding staff are not clinical what training do they need to help them code an asthma exacerbation correctly?
    If coding staff are clinical, are they aware of how to code an asthma exacerbation or record oral prednisolone use? Can patients who have received prednisolone from out of hours services or secondary care be identified?
    You may wish to bring this to a practice meeting to discuss this.

  3. Agree a process for follow up of patients who have had an asthma exacerbation

    You will need to agree a process for follow up for patients who have been identified as having an asthma exacerbation.
    Will they need to be put on a clinician’s phone list for review 48 hours after the exacerbation? Who is the best person to conduct the follow-up review? Is this the on-call doctor? Or the asthma nurse? Your practice pharmacist? Discuss this at a clinical meeting.

  4. Study

    You may wish to re-audit the notes of asthma patients known to have recent exacerbations in a few months to check the agreed processes are working.

Top tip

Observe the coding process in your practice.

Involve your practice respiratory lead.

How to scale this project up or down

Please note - Use of this project requires NetworkPLUS membership. If you would like to share this project with others, please invite them to purchase their own membership—access must not be shared with non-members.

You could upscale this project by taking it to your PCN pharmacy team to implement across all practices in your PCN.  You could go wider and suggest the ICB medicines optimisation team includes it in a Pharmacy Quality Scheme. Use of this project requires a Greener Practice NetworkPLUS membership. If you would like to share this project with other organisations, please invite them to purchase their own membership—access must not be shared with non-members

Have you completed this QIP?

Tell us a little about your project and enter your data in order to generate a certificate showing the cost and carbon savings and other probable benefits. This project may help with CQC evidence submission (see disclaimers).

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