AH ANNUAL REPORT 2018

When a child has
an asthma attack
there is already a
high degree of stress
placed on parents
and carers, and it is
the responsibility of
the hospital staff to
ensure the journey is
as comfortable and
successful as it could
possibly be, and
discharge is achieved
as soon as possible.
Reasons for Change
Hospital admission rates for childhood asthma are
consistently amongst the highest in the UK. There is a
feeling that children in Alder Hey were receiving more
treatments than are needed and this was increasing
length of stay.
The pathway was plotted and was found to have:
• Non-uniformity of care
• Some aspects that did not reflect recent best practice
evidence from clinical trials
• Stress amongst junior doctors and nurses.
Alder Hey adopted an inclusive partnership approach
to seeking to make improvements to this pathway. This
included co-designing the revised pathway with staff
and the parent of three boys suffering from asthma.
The parent was an equal partner in voting about
each recommendation and played a crucial role in
making change. This including teaching the parent
about evidence based medicine and what results
of randomised trials mean, to enable them to make
informed choices.
Improvements
• Utilised a co-design methodology working with
parents to identify the optimal solutions and define a
new pathway
• Reviewed and streamlined the pathway so that it best
suited the needs of the children and families.
• Systematically reviewed medical research with
nurses, doctors, and parents who were involved in
voting about issues with the pathway.
• Incorporated a change in the steroid we use (from
prednisolone to dexamethasone) – resulting in
reduced side effects and reduced frequency of
dosing from three to one per day.
• Reduced costs of medication by 90%
• Reduced frequency of exposure to X-rays from 30%
of asthmatic children to 8%.
This innovative improvement won a national award for
innovation in Pharmacy and the revised pathway is
being adopted by many other trusts across the UK.
Future Plans
• Complete a follow up audit and seek further
opportunity for improvement
• Publish these findings in a medical journal
B. Family and Friends Test
We have gathered information from children and
families through the family and friends test (FFT), a
national tool which provides consistent information that
is comparable to other organisations and is published
externally on both NHS England and NHS Choices
websites. In addition we have added our own bespoke
survey questions and the table below provides a
summary of the responses.
We also informally spoke with parents of younger
children before the pathway was developed to identify
outcomes of importance and also to agree on the areas
of most interest within the guideline.
Alder Hey Children’s NHS Foundation Trust 116
Annual Report & Accounts 2017/18