Improvement of Inhaled Corticosteroid Prescription Rates

Abstract

Objectives Acute wheeze is one of the most common presentations to the paediatric Emergency Department in under 5s and it is associated with significant morbidity and mortality. Up to three quarters of these presentations are thought to be avoidable. Inhaled corticosteroids are the first-line medication in the prevention of acute exacerbations of wheeze, with a significant body of evidence supporting their efficacy. Despite this, inhaled corticosteroids are often underprescribed in this age group. Aim To improve the rate of appropriate inhaled corticosteroid prescriptions in children under 5 presenting to a District General Hospital in London with acute wheeze. Methods The project used a systematic quality improvement approach using the Plan-Do-Study-Act (PDSA) framework. Appropriate prescription criteria were established through consultation of the British Thoracic Guidelines alongside discussion with local respiratory paediatric consultants. Initial data were then collected to determine baseline steroid inhaler prescription rates among children under 5 presenting with acute wheeze. Over the course of four months, seven interventions were initiated including departmental teaching, parent education and dissemination of clinical guidelines throughout the wider multidisciplinary team. Data were collected contemporaneously to assess response to each intervention and inform further PDSA cycles. Results Baseline data suggested that only 33% of eligible children under 5 presenting to the Emergency Department or Paediatric Assessment Unit received new prescriptions of inhaled corticosteroids. This improved throughout the project, with the 8-week average after completion of all interventions rising to 60%. Conclusion This quality improvement project highlights the successful implementation of targeted interventions to enhance the rate of corticosteroid inhaler prescriptions for young children with acute wheeze exacerbations. This has important implications for both the prevention of life-threatening emergencies and long-term child health.