PrescQIPP

Putting guidelines into everyday practice: co-designing solutions to reduce patient’s risks associated with salbutamol over-prescribing in asthma

NAME OF ORGANISATION

Project summary

This project aimed to reduce the risks associated with excessive salbutamol (SABA) prescribing by embedding the NG245 AIR/MART pathway into routine primary care practice. The need for change was clear: prescribing data showed the practice was an outlier for SABA use. It is well established that excessive SABA use is “strongly associated with poor asthma control, increased exacerbations, hospital admissions, and mortality.” National drivers — including the Greener NHS agenda and the MHRA 2025 Drug Safety Update — further reinforced the urgency.

What we did and why

The project addressed clinical inertia, guideline complexity, and variation in practice by applying an Evidence‑Based Emancipatory Practice Development (EBEPD) framework, delivered through Evidence‑Based Co‑Design (EBCD). This enabled staff to identify barriers, reflect on behaviours, and co‑design practical, context‑sensitive solutions. It also responded to the “knowledge‑action gap” from staff feedback. The author applied principles of positive deviance, building on existing strengths within the practice to drive sustainable improvement.

How we did it

A mixed‑methods approach was used:

  • EMIS audit of SABA and ICS prescribing to identify high‑risk patients.

  • Anonymous staff survey assessing knowledge, confidence, and behaviours.

  • Stakeholder engagement through world‑café, informal conversations, protected learning time session.

  • Co‑design of resources, including an AIR/MART prescribing aid, EMIS prompts, and a SABA‑risk awareness poster.

  • Governance and data‑handling aligned with GDPR and HRA guidance.

  • The project was delivered using existing staff time and digital tools, with no financial cost.

Outcomes achieved

  • Staff reported improved understanding of NG245 and greater confidence in AIR/MART prescribing.

  • Co‑designed tools standardised decision‑making and reduced variation.

  • EMIS prompts and prescribing aids were embedded into routine workflow.

  • The practice now has a clear plan for 6 and 12 months re‑audits to measure sustained impact.

  • The project strengthened organisational culture, safe prescribing, and shared ownership of asthma care.

Patient outcomes

Although patient‑level data will be captured in follow‑up audits, expected benefits include:

  • Reduced risk of severe asthma attacks.

  • Fewer unplanned appointments and oral steroids prescriptions

  • More consistent, person‑centred asthma reviews.

  • Improved understanding of inhaler roles and safer self‑management.

Return on investment and savings

The project required only staff time and existing resources, making it a low‑cost, high‑impact intervention. Even modest reductions in SABA use will generate significant savings: salbutamol pMDI costs exceeded £4,000 in one quarter, meaning a 10–20% reduction would outweigh the entire project’s time cost. Additional savings are expected through reduced exacerbations and alignment with Greener NHS priorities.