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ObjectivesExacerbations of asthma and viral induced wheeze are leading causes of morbidity and hospital admission in children and young people. Salbutamol is a mainstay of treatment for these conditions, however there is limited evidence to inform the optimal salbutamol dosing regimen at discharge.1 2 We aimed to investigate the effect of updated salbutamol discharge dosing guidance (1000 microgram 4 hourly) versus the previously followed guidance of 500 microgram 4 hourly in a specialist children’s hospital.MethodsData from the hospital’s electronic patient record was used to identify inpatients with diagnoses of asthma or viral wheeze treated in the year before and two years after the dosing guidance was updated in November 2020. Data from 491 patient records (227 pre-update, 264 post-update) was analysed for salbutamol discharge doses, readmission rates and length of stay.ResultsFollowing the change in guidance, the proportion of patients discharged on 10 puffs of salbutamol 4 hourly, increased significantly from 6.2% to 49.2% (Mann Whitney U value 17057, p <0.05).The seven-day readmission rate increased from 0.0% (n = 0/227) to 2.7% (n = 7/264) (Fisher’s exact test value 0.0168, p <0.05). However, the readmission rates were not significantly different between the cohort of children who were discharged on five puffs of salbutamol (n = 4/134, 3.0%) compared to the group discharged on ten puffs (n = 3/130, 2.3%) (Chi-square statistic = 0.1173, p = 0.739).There was a non-statistically significant reduction in median length of stay between the two periods (27 hours vs. 23 hours (Mann-Whitney U-value = 17177.5, p = 0.9676)).(See table 1)There were no reported clinical incidents associated with the use of salbutamol on discharge.ConclusionDischarging patients on ten puffs of salbutamol proved to be feasible, was associated with a trend towards a reduced length of stay and was not associated with any adverse events. Although there was an increased readmission rate in the period following the change in the dosing guidance, this did not seem to be related to the discharge dose of salbutamol.We conclude that the key factor in guiding patient discharge is the ability to remain clinically stable in the four-hour interval in between the doses of salbutamol rather than the dose of salbutamol itself. Further research, ideally using high-quality prospective study designs, is required to confirm these findings so that clinicians can make evidence-based decisions.Abstract 7771 Table 1[Image Omitted. See PDF.]ReferencesAndrzejowski P, Carroll W. Salbutamol in paediatrics: pharmacology, prescribing and controversies. Archives of Disease in Childhood-Education and Practice 2016 Aug 1;101(4):194–7.Babl FE, Sheriff N, Borland M, Acworth J, Neutze J, Krieser D, Ngo P, Schutz J, Thomson F, Cotterell E, Jamison S. Paediatric acute asthma management in Australia and New Zealand: practice patterns in the context of clinical practice guidelines. Archives of disease in childhood 2008 Apr 1;93(4):307–12.

ObjectiveManagement of wheezy children admitted with viral induced wheeze and asthma involves frequent clinician reviews to wean treatment with salbutamol inhalers. We proposed that a nurse led salbutamol weaning training package would enable the assessment of patients by experienced nurses and would facilitate more timely reviews of wheezy children. Our objective was to assess the feasibility and acceptability of implementing the training package and to explore the nurses’ perceptions of its effects on their confidence to review and wean salbutamol treatment.MethodAfter a literature review and multi-professional consultation, we created a teaching package for eligible nurses working on a general paediatric ward and defined eligibility criteria for patients (see table 1 for patient eligibility criteria). The training package included a pre-recorded educational video, face-to-face clinical examination training and supervised clinical patient reviews with a standardised competency sign off procedure.Nursing staff who participated in the training programme were asked to complete anonymous questionnaires designed to measure the impact of the training on their confidence levels and practice when managing wheezy children.ResultsThe training package was completed by 12 out of the 21 (57%) eligible nurses working on the general paediatric ward.All of the nurses who completed the training(100%) responded to the questionnaire.Before the training only 1/12 (8.3%)nurse felt either extremely or somewhat confident to assess a wheezy child’s salbutamol requirements. After training 12/12 (100%) nurses reported feeling either extremely or somewhat confident. (Graph 2 shows nurses’ confidence before and after training).There was a statistically significant increase in self-reported confidence levels following completion of the training.(Fisher exact test statistic < 0.01)All (100% )nurses surveyed reported a perception that the introduction of the training package would improve patient care and patient/parent/carer confidence in nursing staff’s ability to assess their need for salbutamol. 92% of nurses surveyed found the training beneficial and 67% felt the training had positively impacted on their other nursing practices. Time constraint was identified as potential barrier to implementation of practiceConclusionImplementing a ward-based training package to improve nurses’ confidence to assess and wean salbutamol treatment in wheezy children proved to be feasible and acceptable. Further evaluation objectives include monitoring the effects of the training intervention on key outcomes including length of stay and readmission rates.Abstract 287 Table 1[Image Omitted. See PDF.]