A day in the life: Centre for Severe Asthma
This month, we spotlight our Specialist Nurse Advisor, Fiona Oakley, who shares her valuable insights and experiences gained while working in our Centres for Severe Asthma. Fiona’s work showcases the expertise and dedication required to support patients with this challenging condition.
Through her role, she has developed a deep understanding of the complexities of managing severe asthma and the critical interventions needed to improve patient outcomes. Fiona’s journey highlights the impactful work being completed in CSA and the essential role of our NSHI Nurse Advisors in transforming lives. Let’s take a closer look at her day-to-day responsibilities, challenges, and successes to deliver exceptional care.
My day typically begins at 8:30AM, dedicating the first 30 minutes to thoroughly reviewing my scheduled patients’ records in the clinical system, which includes results of investigations, discharge letters and review of GP summary records. This allows an insight into any potential Difficult Asthma patients with modifiable risk factors. Once these factors are addressed the patients may become Severe Asthma Patients with possible consideration for Biologics.
At 9am my patient list commences. I take the opportunity to obtain a full history, review of current symptom control, and current asthma medications in use. I will complete an extensive assessment addressing any modifiable risk factors that are identified. I have access to a FeNO machine, which is so useful when making decisions on an individual’s management, and I can request investigations where indicated. Once all of this is completed a management plan is formulated with either optimisation of medication and discharge to GP, a further planned review in NSHI clinic, or a referral into the Severe Asthma Consultant Clinic. At the end of the clinic, time is spent writing/dictating GP letters and completing outcome forms.
During my day I have access to the two Respiratory Consultants either by email or in person depending on their schedules, the Respiratory Nurses who have a clinic alongside mine in the same area, and the outpatient staff and pulmonary function technicians, which makes working here more of a team experience. I am also able to attend MDT if I am working on a Tuesday.
Why do you enjoy CSA?
Working within a team is something that I have missed as often in REACT or COPD+ I am lone working and rarely get time to interact with other clinicians. However, in CSA I have been able to discuss patient care with colleagues in real-time and share valuable experiences.
I have enjoyed the learning opportunities that CSA has given me, in particular, a better understanding of severe asthma and recognising the appropriate work up required to be ready for biologic consideration. Working in CSA has also given me the opportunity to grow professionally.
Did you receive extra training?
Yes, I had training in Difficult/Severe Asthma and was able to shadow two of my colleagues in other CSA clinics. I was also supervised/mentored by the lead for CSA in clinic until I was validated. Unfortunately, I felt that I needed a little more training following several very complicated cases which affected my confidence, and following discussion with Sonia, my manager and mentor, I obtained further support and training which has proved invaluable.
What challenges have you faced?
Initially the greatest challenge has been getting to grips with secondary care IT systems and learning to create clinical letters and dictating these onto the system. I have had support from the Pinderfields team with IT which has been great, and Sonia demonstrated letter formats and provided support initially, therefore both challenges were made easier to overcome.
Another challenge for me has been the learning required to be able to understand Difficult/Severe Asthma and Biologics. This is still ongoing as there is so much to learn, the more I know the more there is to learn!
How has CSA improved patient care?
The waiting list for asthma discharge reviews has been considerably reduced and patients are now being invited for review within a more appropriate timeframe. When we started there was a 4-month waiting list and this has now reduced to 4-6 weeks.
Patients are being identified earlier as potential candidates for Biologics following the improved waiting times, and the appropriate work up for this is being completed in NSHI clinics, meaning patients are being seen in specialist clinics ready for treatment planning.
In 2025 NSHI clinics will include patients who have been referred to consultants for initial screening and on-going management, ensuring that the Severe Asthma Team are only seeing those who are require their skills. This will significantly reduce waiting times for those in need of more expert care.
The work Fiona and the team at NSHI carries out in CSA is essential to ensure patients are seen, treated, and managed effectively. Asthma can be a complex and intimidating condition for many patients, and our efforts play a crucial role in maintaining high standards of care. By supporting patients and clinicians, we help guarantee that asthma care is delivered with precision and compassion, improving outcomes and providing peace of mind.