7 Implementation

7 Implementation

7.1 NHS organisations and clinicians (including primary care teams, accident and emergency staff, and specialist paediatric and respiratory staff ) should review local practice and policies regarding the prescription of inhaler devices for children between the ages of 5 and 15 with chronic asthma to take account of the guidance set out in section 1.

7.2 Where local guidelines or care pathways for the care of older children with asthma exist, they should incorporate the guidance set out in section 1.

7.3 Arrangements should be made to ensure that clinical staff (i.e. doctors and nurses) involved in the prescribing, supply and administration of inhaler devices to children:

  • receive suitable education and training in the role of inhaler devices in the treatment of childhood asthma

  • give sufficient explanation of the full range of inhaler devices available and offer these to children who need them

  • give effective training in the proper use of devices selected.

7.4 To audit local compliance with the guidance set out in section 1, the following criteria can be used:

  • For a child aged 5-15 years being prescribed an inhaler device for asthma for the first time:

    • the child's therapeutic needs and personal needs and preferences are considered when selecting an inhaler device

    • when inhaled corticosteroids are prescribed, a press and breathe pMDI and a suitable spacer device are prescribed, consistent with the doctor's assessment of the child's actual or likely adherence to the therapy

    • the child and the child's parent(s) or carer(s) receive effective training in the use of the inhaler device selected

    • if more than one device is appropriate for a child, the least costly device is selected.

  • For a child aged 5-15 years who has already been prescribed an inhaler device:

    • the child's adherence to therapy and inhaler technique is monitored on an ongoing basis

    • the child's inhaler-related needs are reviewed at least annually to ensure that the device prescribed continues to meet the child's needs.

      See Appendix D for technical detail on the use of the criteria for audit purposes.

7.5 Local clinical audits on the care of older children with chronic asthma could also include consideration of the measures identified for audit by the British Thoracic Society guidelines.

7.6 Primary care teams also may wish to consider monitoring their prescribing of inhaler types in comparison with other primary care teams.