Hull and East Yorkshire set up a paediatric asthma task force in 1998 with representatives from health, education, social services and community health. It quickly identified that the priority was to improve the management of asthma in schools; there was no standard approach and no specific information and support. This is where I came in. There are lots of respiratory nurses, but they tend to be linked to hospitals. Half of my work is clinical, but the other half is about going into schools, meeting pupils, parents and teachers, and finding ways to make information on asthma accessible to everyone.
We started by sending a questionnaire to every school. It helped us establish that there were particular issues about the number of inhalers being used and access to them; we also asked specific questions of staff who help to administer drugs. The response was excellent, both in numbers and in its positive tone, and this encouraged us to set up a working group to put together a policy on asthma which could be used for all schools.
Working with the local authority, we decided to include a paragraph about indemnity to reassure staff that they would have support if something should go wrong when they were helping a child with asthma.
Schools have welcomed the guidelines, which are clear and simple. For example, staff were having to deal with a range of coloured inhalers. The guidelines made it clear that only one - the blue reliever inhaler - was needed in school. There is also a flow chart that explains the signs and symptoms and what to do in an attack. It’s simple to follow and if staff need to act quickly they know where to go for advice.
Having guidelines is all very well, but staff need to be confident about using them. Training was fundamental to our plans.With only one full-time asthma specialist nurse and 257 schools, we devised a two-day course for school nurses who were then able, with support from me, to deliver the training in their own schools. Teachers’ knowledge about asthma is patchy, even though so many children are affected, so it’s important to back up the written information and to give staff the opportunity to ask questions. And then, of course, we have to educate children. At primary level we have developed an interactive puppet show that deals with all the issues in an entertaining way. It’s important that everyone gets to see it, not just those children who have asthma, so that we can raise awareness among their peers as well.
Secondary schools are much harder to access. Teachers don’t always know who has asthma, often because inhalers are kept tucked away in pockets and bags, so it’s not obvious who needs support. But we still plug away. We’ve developed an approach which links work on asthma with work on smoking, so when there are “health” days in school, asthma is one of the key topics.
We’ve made tremendous progress, especially on access to inhalers. A high percentage of schools have changed their practice, and inhalers are much less likely to be locked away. But there’s still lots of work to be done on getting information out to people. Parents need to be reassured that staff will know what to do. My work helps to allay their anxieties. I’ve gone all out so that staff can be confident in dealing with asthma and children can be safe.
Daryl Perkins is paediatric asthma specialist for the Hull and East Yorkshire primary care trust. She was talking to Steven Hastings
