In this section
Asthma is a respiratory problem that affects one in nine children in Australia, and is the most common reason children visit hospitals. At the Royal Children’s Hospital (RCH) it is one of the leading causes of presentation to the Emergency Department. Providing appropriate education and self-management skills to these families will help to decrease the number of asthma presentations to the hospital.
The aims of this guideline are:
For acute asthma management please refer to RCH CPG - Asthma acuteAsthma education is the responsibility of all nurses from all departments at RCH. It is important the information provided is consistent. Education should be commenced as soon as practicable following admission to allow for timely discharge. Ongoing management and support post discharge should also be considered via the Complex Asthma Service or Community Asthma Program (please see Discharge Planning later in the guideline).
Patients and parents/carers should be presented education in several formats:
Important factors to cover are:
It is important to ensure patients and parents/carers have an understanding of every medication prescribed, including Salbutamol, and if applicable Prednisolone and Preventers. It is important that they understand:
A spacer device should be used for children of all ages, including adolescents, whenever they use a MDI. Ensure the patient and parents/carers are able to demonstrate correct technique when using the MDI and spacer (including correct placement of mask and shaking MDI between each puff), and that they understand the appropriate cleaning and storage requirements.Provide and explain the Kids Health Info: Asthma - use of spacers fact sheetRefer families to Kids Health Info: Asthma – videos for demonstration of spacer technique
Provide the patient and parents/carers with a WAAP and go step by step through the plan, ensuring they understand what is written, and highlighting when to present to their GP or hospital (i.e. needing reliever more frequently than 3 hourly). Families need to be aware of the importance of following this plan when their child/adolescent has asthma symptoms. The WAAP must only be completed by medical staff.Ensure that the patient and parents/carers understand their Asthma Emergency First Aid requirements - i.e. 4x4x4 rule (as documented under ‘Danger Signs and Critical Asthma First Aid’ section of the WAAP).Advise parents to give Salbutamol for asthma symptoms only as required. Written plans for weaning of Salbutamol are not recommended.
It is important to highlight to families the adverse effects of cigarette smoke exposure on children/adolescents with asthma. If you are not comfortable with talking to parents about this subject, your AUM/senior RN could be of assistance.If support is required in relation to quitting you can refer patients/parents/carers to Quit or their local GP.
All patients admitted to RCH with asthma should have the appropriate ‘Inpatient Asthma Education’ elements added to their Education record in EPIC, if these have not been previously added. It is then the responsibility of the RN on each shift to document the patient’s and parent/carer’s progress in relation to this education. For each new admission, the status of the patient’s and parent/carer’s education should be reviewed to ensure that they maintain a good understanding of all the education elements.
All patients with asthma should have a clear follow up plan on discharge. This may include:
Signs/symptoms – Able to identify asthma signs and symptoms, including what is normal for their child, so they can better appreciate the signs when their child is unwell
Puffs (medication) – Know how much Salbutamol to give their child (6 puffs <6yrs, 12 puffs >6yrs), and understand their child’s preventer medication and adherence strategies
Spacer technique – Able to demonstrate correct spacer techniquePlan – Know when to attend GP, hospital or call 000 (as per WAAP)
Parents Information (Kids Health Info)
The evidence table for this guideline can be viewed here.
Please remember to read the disclaimer.
This nursing guideline was updated by Katie Rogers and Adele Berry, CNC’s - Complex Asthma Service, and approved by the Nursing Clinical Effectiveness Committee. Updated November 2021.