Quality standard

Quality statement 2: Documented personalised action plan

Quality statement 2: Documented personalised action plan

Quality statement

People aged 5 years and over with asthma discuss and agree a documented personalised action plan. [2013, updated 2018]

Rationale

Involving people with asthma (including their families and carers as appropriate) in developing a documented personalised action plan can help them to respond to changes in their symptoms, enabling them to self‑manage their asthma and reduce the risk of serious asthma attacks and hospital admission. Regular reviews of the action plan with a healthcare professional can help to prevent complications arising. The action plan should also be reviewed if the person's asthma control is deteriorating, including during hospital admissions and acute consultations.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured and can be adapted and used flexibly.

Structure

Evidence of a local framework and guidance for healthcare professionals on providing asthma education and developing a documented personalised action plan for people aged 5 years and over with asthma.

Data source: Local data collection, for example, service protocol.

Process

a) Proportion of people aged 5 years and over with asthma who have a documented personalised action plan.

Numerator – the number of people in the denominator who have a documented personalised action plan.

Denominator – the number of people aged 5 years and over with asthma.

Data source: NHS England's Quality and Outcomes Framework indicator AST007 includes data on personalised action plans as part of an annual asthma review. The Royal College of Physicians National Respiratory Audit includes data on documentation of a current self-management plan following an admission to hospital due to an exacerbation for adults, children and young people with asthma.

b) Proportion of documented personalised action plans for people aged 5 years and over with asthma that include approaches to minimising exposure to indoor and outdoor air pollution.

Numerator – the number in the denominator that include approaches to minimising exposure to indoor and outdoor air pollution.

Denominator – the number of documented personalised action plans for people aged 5 years and over with asthma.

Data source: Local data collection, for example, audit of patient health records.

Outcome

a) Rate of hospital attendance or admission for an asthma attack.

Data source: NHS Digital's Hospital Episode Statistics includes data on admissions and A&E attendances for asthma attack.

b) Satisfaction of people with asthma aged 5 years and over and their family and carers (as appropriate) that they are able to self-manage their condition and their asthma is well controlled.

Data source: Local data collection, for example, patient and carer surveys. NHS England's GP patient survey includes data on how confident people with lung or breathing conditions are in managing any issues caused by their condition.

What the quality statement means for different audiences

Service providers (such as GP practices, community health services and hospitals) ensure that processes are in place to involve people aged 5 years and over with asthma, and their family and carers as appropriate, in developing a documented personalised action plan and to provide education to help them self-manage their asthma. Service providers ensure that healthcare professionals are able to explain that pollution can trigger or exacerbate asthma, and include approaches for minimising exposure to indoor and outdoor air pollution in personalised action plans. Service providers ensure that documented personalised action plans are reviewed regularly, including after an asthma attack.

Healthcare professionals (such as doctors, nurses, healthcare assistants and pharmacists) involve people aged 5 years and over with asthma, and their family and carers as appropriate, in developing a documented personalised action plan and provide education to help them self-manage their asthma. Healthcare professionals explain that pollution can trigger or exacerbate asthma, and include approaches for minimising exposure to indoor and outdoor air pollution in the personalised action plan. Healthcare professionals regularly involve people with asthma in reviewing and updating their documented personalised action plan, including after an asthma attack.

Commissioners commission services that involve people aged 5 years and over with asthma, and their family and carers as appropriate, in developing and reviewing a documented personalised action plan and provide education to help them self-manage their asthma. Commissioners should ensure consistency by providing a local framework and guidance to healthcare professionals on developing and reviewing documented personalised action plans and providing education for people with asthma.

People aged 5 years and over with asthma have their own asthma care plan, which helps them take their asthma medicines and know what to do if the medicines are not working (with support from their family and carers as appropriate). Their healthcare professional gives them (and their family and carers as appropriate) information about asthma, involves them in developing the plan and helps them to use it. Their healthcare professional also explains that pollution can trigger or make their asthma worse and ensures their care plan includes ways to reduce exposure to indoor and outdoor air pollution. The care plan is reviewed regularly with the person's healthcare professional and also reviewed after an asthma attack.

Definitions of terms used in this quality statement

Documented personalised action plan

A documented personalised action plan should be tailored to the person with asthma, enabling them to recognise when symptoms are worse. In adults, they may be based on symptoms or peak expiratory flow (or both) but symptom-based plans are usually preferred for children. The plan should include approaches for minimising exposure to pollution and any other personal triggers. It should set out actions to be taken if asthma control deteriorates and who to contact. For adults aged 17 and over who are using an inhaled corticosteroid in a single inhaler, the action plan should outline how and when to increase their dose of ICS for 7 days, and what to do if symptoms do not improve. [Adapted from BTS, NICE, SIGN guideline on asthma, recommendations 1.14.1, 1,14.4, 1.14.5 and expert opinion]

Equality and diversity considerations

Healthcare professionals should have a discussion with family or carers of children under 5 years with suspected or confirmed asthma to agree if a documented personalised action plan would be helpful. [BTS, NICE, SIGN guideline on asthma, recommendation 1.14.3]

The personalised action plan should be provided in an accessible format and tailored to meet individual needs, taking into consideration a person's capacity and their ability to care for themselves. Additional support may be needed for people with learning disabilities to ensure that they can be involved in the discussion and are able to understand how to use their plan.