Audit and Quality Improvement Project on Uptake of the New Asthma Guidelines at SAMManchester
Dr. Vunyorohwashe Makurira, from Royal Cornwall Hospitals NHS Trust, presented an audit and quality improvement project at the Society for Acute Medicine’s 18th International Conference (SAMManchester 2025). The work examined how effectively the new national asthma guidelines, introduced in November 2024, have been adopted in clinical practice across the Trust.
Background: What Changed?
The updated asthma guidelines brought a major change in practice. Short-acting beta agonists (SABA) alone are no longer recommended, as their use has been linked to increased risks of severe exacerbations and mortality. Instead, the guidelines advise prescribing anti-inflammatory reliever (AIR) therapy or maintenance-and-reliever therapy (MART), using low-dose ICS/Formoterol (Symbicort Turbohaler 200/6).
The Audit
An initial audit, carried out between January and March 2024, reviewed prescribing practice for patients discharged from the Emergency Department (ED) and for inpatients.
The results showed clear variation. In the ED, 67% of patients were discharged on the wrong regimen, whereas adherence to the new guidelines was much better among inpatients.
Quality Improvement Measures
To improve practice, the team introduced targeted interventions:
Educational posters displayed in clinical areas.
Teaching sessions delivered to junior doctors and ED staff.
Multidisciplinary collaboration, with respiratory nurses and pharmacy colleagues actively involved.
Electronic prescribing alerts (EPMA) and discharge packs created by pharmacy to reduce SABA-only prescribing.
The Outcomes
On re-audit, which is ongoing, the project has demonstrated encouraging results:
Improved adherence to guideline-recommended inhalers.
Reduced inappropriate SABA prescribing.
Fewer asthma-related re-attendances.
Reflecting on the findings, Dr. Makurira said:
“This audit and quality improvement project showed how education and collaboration can quickly embed new guideline practice into everyday care and lead to better outcomes for our patients.”
Looking Ahead
The Royal Cornwall Hospitals NHS Trust team will continue to monitor prescribing practice for both ED discharges and inpatients through further audits to ensure improvements are sustained.
The conference also looked ahead to an important milestone: the Society for Acute Medicine’s 19th International Conference, which took place on 22–23 September 2025 at Manchester Central marked 25 years since SAM was founded, bringing the acute medicine community together to celebrate and share progress.
