812 Use of salbutamol for bronchiolitis in infants under the age of one: a quality improvement project evaluating the practices in an NHS emergency department

• Published in: Archives of disease in childhood 2021-10, Vol.106 (Suppl 1), p.A123-A124
• Main Authors: Forsyth, Jessica, Ward, Jocelyn, Osborne, Claire, Sell, Tim
• Format: Article
• Language: English
• Subjects: Abstracts; Age; Anaphylaxis; Bronchopneumonia; Children; COVID-19; Data collection; Emergency medical care; Emergency medical services; Guidelines; Hospitals; Infants; Pandemics; Patients; Pediatrics; Quality control; Quality improvement; Respiratory function; Respiratory tract; Respiratory tract diseases; Salbutamol; Teaching Methods; Young Children
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2021-rcpch.214

BackgroundThe National Institute for Health and Care Excellence (NICE) guidelines do not currently recommend the use of salbutamol in infants under the age of 2 years due to lack of evidence of effectiveness and concerns about harm. It has been estimated that only 17–27% of UK clinical practice may be compliant with these guidelines. In February 2020 the Joint Royal Colleges Ambulance Liaison Committee (JRCALC)) changed their guidelines for managing respiratory distress in children, emphasizing that salbutamol is rarely effective in children under 1 year of age.ObjectivesWe conducted a quality improvement project assessing the use of pre-admission nebulised salbutamol in infants under 12 months brought in by ambulance to an English NHS Emergency Department (ED), before and after the change to the JRCALC guidelines.MethodsThe audit compared two periods: November 2019; and November/December 2020. Two months were required in 2020 to increase the number of patients included. Electronic patient records for November 2019 were retrospectively audited. Inclusion criteria included: all children under 1 year old brought in by ambulance with an initial presentation documented as respiratory distress and/or a final ED discharge diagnosis of bronchiolitis, upper respiratory tract infection, lower respiratory tract infection or viral induced wheeze. We recorded whether these children were treated with nebulised salbutamol before arrival. We then developed an educational video in September 2020 highlighting the above mentioned JRCALC guideline changes and shared it on the Oxfordshire paramedics teaching website. We then conducted a repeat audit for November and December 2020.ResultsIn November 2019, 53 infants were brought in by ambulance to our ED fitting the inclusion criteria, of which 9 (17%) had been given nebulised salbutamol by the paramedics. In November and December 2020, 19 infants met inclusion criteria, of which 2 (15%) received salbutamol from the paramedics. The two patients who received salbutamol were less than 6 months old and were not diagnosed with viral induced wheeze or anaphylaxis.ConclusionsThe JRCALC guidelines for salbutamol were adhered to in 83–85% of the pre-hospital cases that were audited. The change in salbutamol practice between audit cycles was small, however analysis is limited by the low number of patients. Unfortunately, only 4 paramedics watched our video; this may have been related to the pressures of the COVID -19 pandemic that were