GASP: a breath of fresh air for asthma nursing?

1 June 2010

Getting asthma under control is the aim of the simple web-based tool GASP, targeted at nurses and GPs. And its success in helping cut hospital admissions and exacerbations has made it an award winner. Fiona Cassie talks to Wendy McNaughton, the respiratory nurse behind GASP

Wendy McNaughton has been there, done that.

Asthmatic from age five, she was puffing on her blue inhaler up to six times a day.

But better medication and management means she hasn’t needed a relief inhaler for more than a decade.

The British-trained nurse is passionate about helping others get their asthma under control. She wants to get the message across that many more can be symptom-free.

“With the right support and education they can not only turn their asthma around but also turn their lives around,” says McNaughton. “So days off school or days off work become something in the past.”

The aim of the GASP tool is to standardise and speed up asthma clinical assessment and provide personalised best practice advice to the clinician for improving asthma management for each patient.

The tool calls on the expertise McNaughton has built from specialising in asthma for 20 of her 30 years of nursing.

She says common problems in asthma management include poor inhaler technique, not knowing what the different inhalers do and concerns about steroids. The result can be acceptance of asthma symptoms that can be controlled with the right medication and support.

It was her work in training other nurses to run nurse-led asthma clinics that prompted her to see how useful an online tool – that simplified calculations and prompted best practice advice – could be.

After moving to New Zealand in 2001, McNaughton started work first as a specialist practice nurse in Silverdale, north of Auckland, then soon after took up her current role as respiratory programme manager for the Harbour Health primary health organisation.

She still does one nurse-led respiratory clinic a week at Silverdale to keep her hand in, but her main focus is offering respiratory training to practices across the North Shore and urban Rodney area.

About 250 nurses have been through the Harbour Health’s GASP (Giving asthma support to patients) asthma course in the past eight years, leading to many nurse-led clinics across the district. McNaughton said the course built on the NZQA-accredited Asthma and Respiratory Foundation’s fundamentals course with additional components built in, like assessment and diagnosis of asthma/COPD (chronic obstructive pulmonary disease) and how to set up a nurse-led clinic.

Initially the nurses were trained in using a paper-based clinical assessment tool. But the paper tool had its limitations including it being difficult for McNaughton to audit what impact the assessment and clinics were having on patients’ asthma management.

The nurses were also reporting the paper tool was cumbersome. “I thought it would be really good if you could have it with a touch of a button.”

Working with Murray Speight, an IT specialist from Comprehensive Health Services, the pair spent two years developing the GASP tool. It had early support from the Asthma Foundation (of which McNaughton is an advocacy and education committee member) and in 2008 the pair emerged with the final model which has also won the foundation’s endorsement.

Use of the tool became part of Harbour Health’s respiratory training course and is used in its nurse-led clinics.

McNaughton says the decision support advice generated by GASP follows the New Zealand, British Thoracic Society and the GINA (Global Initiative for Asthma) asthma guidelines “to the letter”.

She says this means nurses and GPs using the tool are “all singing from the same song sheet” making it much easier to follow best practice guidelines that can otherwise end up sitting on shelves gathering dust.

The tool provides “decision support” advice to the nurse or GP about whether a patient is being over- or under-medicated and when education is needed to improve inhaler technique or to get better adherence to preventer use. At the push of a button the clinician can also print out advice to the patient on how to better manage their particular asthma triggers, be they animal hair, cold or pollen. The tool also enables input of spirometry readings to help assess whether the patient should be further tested for COPD. (A variation of GASP for use with COPD patients is currently under development.)

With calculations done automatically and personalised action plans printed out with the push of a button, the GASP tool’s aim is to free up more time for one-on-one education to improve a patient’s asthma management.

The tool has also given McNaughton the ability to audit what difference it makes to asthma management.

The audit covered 205 Harbour Health patients aged five to 64 years old, 12 months before and 18 months after starting to use the GASP tool.

It found hospital admissions declined by 76 per cent (21 per cent before GASP and five per cent after); exacerbations declined by 58 per cent over the 18-month period (down from 102 per cent to 43 per cent); and courses of oral corticosteroid decreased by nearly half (down from 86 per cent to 46 per cent courses).

The GASP tool was the overall winner of the 2009 Waitemata DHB Health Excellence Awards and the tool and training package have been sold to several other regions with interest also now coming from Australia and the States.

This month McNaughton and Speight are on a whistlestop tour of the United States promoting the GASP tool as one of the ten successful finalists in New Zealand Trade and Enterprise’s Focus on Health innovation challenge.

The success is welcomed, but McNaughton’s biggest hope is that GASP will help nurses help more patients with asthma to live a symptom-free life. ✚