The compliance to acute asthma management protocols in paediatric emergency department.

Asthma guidelines should be followed closely to ensure improvement and consistency of outcome. In order to measure compliance with local acute asthma protocols, we reviewed notes of children presenting to our ED with acute asthma. We noted clinical assessment of severity of asthma exacerbation, compared management of cases with local protocols, noted time to first nebulisation, discharge advice and follow up plans. Retrospectively, 6 patients had life-threatening, 70 had severe and 64 had mild-to-moderate exacerbation. We observed inconsistent documentation of clinical signs including, respiratory effort 6 (100%), 62 (89%), 39 (61%), mental status 3 (50%), 46 (65%), 47 (73%) and speech 1 (16.7%), 19 (27%), 7 (11%) in life threatening, severe and mild-to-moderate groups respectively. Bronchodilator therapy was delayed in life-threatening 3 (50%) and severe cases 63 (90%). While discharge advice was documented in 54% patients, no written asthma action plans were given. This study demonstrated necessity of protocol-adherence in areas of clinical assessment, management and follow up.