SABA overuse in asthma: strengthening systems

Identify which staff are involved in prescription requests and medication reviews.

This could be reception staff, admin, pharmacy colleagues, nurses and doctors.

Show staff how to identify SABA overuse

Organise an update session to show staff how to check inhaler prescriptions requests and identify SABA overuse. The aim is to for staff to feel confident to check how many SABA issues a patient has had over the last 12 months and identify SABA overuse.

Educate staff on how to identify SABA overuse for patients with asthma. Ensure this is only for asthma patients as more frequent SABA use may be appropriate in other conditions. If it is unclear which condition the patient is using inhalers for, defer to a clinical member of staff for clarification.

The Primary Care IT guide shows how to check SABA use, ICS prescriptions and oral prednisolone use. It can be taught in a brief training session and then kept accessible for reference. Staff should check for SABA over-reliance and ICS use during the medication review.

Resource:

• PCIT guide to checking medication issued on EMIS
• PCIT guide to reviewing issued medication on Systm One

Create a process for managing requests for SABA if patient is identified as overusing SABA

Identify a process for following up patients who have been identified as being over-reliant on SABA. Discuss the appropriate process with the team and develop a Standard Operating Procedure (SOP). An example SOP, with a number of follow-up options, is shown below. You may wish to start by focusing on patients who are using more than 5 SABA a year, You may need to adapt this to your practice.

We suggest that patients request for salbutamol is issued for safety reasons, but this is then followed up for review.

Stengthening default SABA prescribing systems

Strengthening default systems:

Some practices choose not to put salbutamol pMDI on repeat for patients with asthma. If at asthma review, a patient continues on separate SABA and ICS inhalers (instead of ICS-formoterol combination inhaler), the practice could issue 1 or 2 SABA inhalers and advise the patient that if they need more than 2 SABA in 12 months, they need a review.

If Salbutamol pMDI is put on repeat, ‘issue duration’ can be changed and/or ‘max issues’ can be added to alert clinicians to SABA overuse. For example, an issue duration of 90 days would ensure patients did not receive more than 5 SABA inhalers a year and 180days would ensure no more than 3 SABA inhalers a year.

Max issues could be set to 2 or 5 SABA per year, depending on the current SABA use and what was agreed by the clinical staff.

This support article explains how this can be done in EMIS

Study

Measure the change has lasted e.g. 3-6 months and use the Project Monitoring form to keep track.

Information to patients about SABA overuse

Patients need to understand that they are being contacted to improve their asthma control and that  SABA overuse is a marker of poor asthma control. You could put up posters abut SABA overuse in your waiting room or clinical areas such as the example below.

Poster on Overusing SABA from Primary Care Respiratory Society

It may be useful bulk message all patients with asthma. You may also wish to send this message in a targetted way to asthma patients who are identified as overusing SABA.