On this page
The benefits of this project
Benefits for Your Patients
- Reduces risk of asthma attacks and deaths
- Improves quality of life by reducing symptoms and increasing ability for physical activity
- Reduces health inequalities as poorly controlled asthma more common in disadvantaged communities.
Benefits for Your Practice
- Reduces workload by improving reducing need for unscheduled care due to poorly controlled asthma
- Reduces workload for prescription requests in the longer term
- Costs of poorly controlled asthma estimated as 52% higher that well controlled asthma
Benefits for The Planet
- Well controlled asthma has 1/3rd of the carbon footprint of poorly controlled asthma
Opportunity for improvement
- The accepted definition of short-acting beta agonist (SABA) overuse is more than 2 SABA inhalers a year. SABA overuse is a marker of poor control.
- The National Bundle of Care for Children and Young People with Asthma recommends reviewing all children on 3 or more SABA inhalers per year.
- This project aims to strengthen your practice’s systems to identify and SABA overuse.
- Most SABA inhalers prescribed in the UK are pressurised metered dose inhalers (pMDIs). pMDIS have a very high carbon footprint and are responsible for 13% of the emissions of the NHS that it directly control. For patients with asthma, most of these emissions are from the overuse of SABA inhalers directly linked to poor asthma control.
- (see disclaimers)
How to carry out this project
-
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 on request and to action the request accordingly.
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.
Resource: Standard Operating Procedure for SABA overuse
-
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.
Resource: Example SMS about risks of SABA overuse
If you need to use more than two salbutamol (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 2 (or 5) salbutamol (blue) inhalers a year without a check from a healthcare professional. For more information have a look at this video https://bit.ly/3TiNoVL or read this leaflet https://bit.ly/4mT5DPn
Top tip
Reception staff who take patient prescriptions requests for salbutamol are key to this project. Ensure they understand that this project is about improving patient care and safety and not about denying patients their medication.
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).
More project guides
-
Extreme Cold Weather Alert QIP
Carbon saving potential: Solid
<10 hours
-
Bath & Shower Emollient Deprescribing
Carbon saving potential: High
<10 hours
-
Reducing Emissions Associated with Banking
Carbon saving potential: Very high
20-40 hours
-
Switching Energy Provider
Carbon saving potential: Very high
<10 hours