Discharging paediatric patients with acute wheeze with salbutamol - Out with the old (weaning) and in with the new (as required)
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Authors
Safdar A.
AlMuwali A.
Eldeeb S.
Magzoub A.
Bader, M.
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2025
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Objectives: To assess the impact of transitioning from a weaning salbutamol discharge plan to an as required (PRN) regime. Areas assessed include adherence to best practice standards at discharge, as outlined by the British Thoracic (inhaler technique checks, asthma action plan provision, 48 hour review), and paediatric accident and emergency metrics - both quantitative (unexpected hospital re-attendance rates), and qualitative (feedback from parents regarding patient experience). Method(s): A retrospective audit was conducted measuring adherence to best practice at discharge. The intervention was then executed, this included 11 teaching sessions about best practice and education about changing from the weaning regime to the PRN salbutamol guideline. A post intervention audit was then completed to compare best practice at discharge, and gather qualitative feedback from staff and parents about the PRN salbutamol guideline. 1007 Pre intervention (n = 33): Patients discharged on a salbutamol weaning plan. Intervention - 11 teaching sessions about best practice at discharge and the PRN discharge plan. Post intervention (n = 31): Patients discharged on a PRN salbutamol plan. Result(s): A total of 64 paediatric patients were audited. After switching to the PRN plan, 90% of patients were discharged with the PRN regimen, inhaler technique checks improved (91% vs 79%), and the completion of the paediatric asthma discharge checklist increased (30% vs 3%). 48 hour review remained consistently high across both periods (~85%), while hospital re-attendance rates within 7 and 28 days slightly decreased with the PRN plan. Conclusion(s): Changing form weaning to PRN salbutamol, and a robust educational programme about best practice, led to improved patient outcomes, and positive feedback from parents. This highlights the importance of empowering parents to assess children and recognise increased work of breathing, administer treatment based on symptoms, and understand when hospital attendance is indicated.
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Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology