Introduction The Challenge The 2015 BTS Paediatric Asthma Audit had showed unit’s performance at delivering a Written Management Plan (WMP) at discharge to have deteriorated to 2%. The same audit found a national average of 50%. We were concerned about how to improve this. In 2016 the BTS introduced the Asthma Care Bundle.

Method We asked staff why they did not always use the bundle. We designed A4 posters, an A4 mouse mat, group training delivered by nursing staff, real time private one to one feedback to nurses and doctors who forgot to use the bundle, group teaching by a nurse (VM), regular reminders by a consultant of the audit (JF) and an audit by a medical student (NP). A department Asthma Care Pathway was updated (LN) to encourage staff to use the discharge bundle. NP and did a retrospective case note audit of admissions between 1/9/16 to 20/1/2017 comparing the number of children discharged with a new and previous WMP who had an asthma care pathway (ACP), diagnosis of asthma, on inhaled corticosteroids (ICS) and those between 2–5 years and over 5 years of age.

ResultsThe use of WMP at discharge rose to 50% for children diagnosed with asthma and 80% for those using an Asthma Care Pathway including the BTS Asthma Care Bundle.

Conclusions and Implications Implementing the BTS discharge bundle in paediatrics is hard work. The neglect of this hard work is associated with a decrease in WMP use. Multiple tools and clear guidelines were effective at improving use by staff. Most important appears to be the use an ACP.