Challenging health inequalities – accessible eczema care plans

Key learning:

  1. Care plans designed by healthcare professionals alone are not always transferable to ‘real life’ for patients.
  2. Care plans should be individualised for patients and presented in a way that they can understand.
  3. Learning from others’ lived experience is meaningful to patients.
  4. Important snippets of information get lost when there is lots of writing.
  5. Patients prioritise different information to healthcare professionals.

Background to learning

Atopic disease is an umbrella term that captures eczema, food allergy, allergic rhinitis and asthma. Increasing in prevalence, with only hypotheses as to why, atopic disease has a notable impact upon a person’s health and wellbeing and quality of life; this can also be applied to their family. Ensuring the effective and timely treatment of these conditions is key to improving health outcomes and the quality of life for children, young people and their families.

Before the pandemic, a Clinical Nurse Specialist in the Children’s Allergy Team at a North London Trust recognised instances where patients had received a care plan that did not appropriately consider the literacy needs of their family.

In response to this, the team collaborated with families to create and integrate accessible eczema care plans into allergy practice. During the COVID-19 pandemic, face-to-face reviews were suspended, and the team had to find innovative ways to consult patients. This case study explores how individualised care plans for the treatment of eczema were utilised throughout the pandemic.

Learning and advice to be shared

When assessing a patient, healthcare professionals evaluate the severity of eczema and topical treatments are then recommended. Different areas of the body often require different strengths of treatment.

Before the pandemic, a child was admitted to the trust who required assessment and treatment for his eczema. Having communicated with the patient and family it was identified that, in this case, written information was not appropriate due to limited literacy ability. To better meet the needs of family a pictorial plan was devised; a basic body map was colour-coded to represent the topical treatments and their corresponding areas of application.

This experience prompted reflection on how appropriate the original care plan design was for the diverse population of North London.  Areas of dense written information were reduced, and consideration given to producing these care plans in a range of languages. NICE guidelines on eczema care as well as information provided by the Medicines and Healthcare products Regulatory Agency’s (MHRA) were used to ensure the information included in care plans was up-to-date and evidenced-based.

The nursing team also collated care plans from other similar services and a team of multidisciplinary healthcare professionals were consulted for opinion. The developed care plan was reviewed by service users’ parents and a questionnaire was used for feedback as to its usefulness and effectiveness in relation to the previous care plan. Feedback was overwhelmingly positive with parents reporting they felt that the new plan was ‘laid out clearly’, and that it was ‘easy to understand and follow’.

Over the course of the first wave of the COVID-19 pandemic, the team conducted eczema reviews remotely. In light of their success pre-pandemic, personalised care plans were devised and reviewed by the parent or carer supported by the nurses during these consultations. Care plans were adapted to complement digital consultations; for example, the use of visual plans allowed complex information to be better communicated and reviewed remotely. The team would then email a prescription request to the patient’s GP who forwarded this on to the local pharmacy for the family to collect in their local area.

When face-to-face clinics were safe to be resumed, a recovery plan was undertaken with the youngest patients of weaning age with a clinical need for allergy testing prioritised, with prompt food introductions recommended. This continuity of care throughout the pandemic meant that families continued to be supported with eczema control, skin was in good condition for skin prick testing and, anecdotally, the team felt that there was less sensitisation on skin prick testing when compared to previous practice.

Would it be beneficial to retain these changes?

Both before and during the pandemic, the development of an individualised eczema care plan was welcomed, highlighting the positive experience patients feel when care is personalised. Parents and carers felt engaged in the child’s treatment and allowed atopic eczema to be controlled efficiently and timely.

The use of these care plans, coupled with digital technology, allowed the continuation of care throughout challenging times and facilitated better eczema control.

The benefits of personalised care and support planning have already been recognised and promoted across health and social care services. Personalised care is one of the five major practical changes to the NHS that will take place over the next five years, as set out in NHS Long Term Plan. Innovations that support personalised practice will be welcomed in embedding this change.

Case study by Sinéad Doherty, Clinical Nurse Specialist Children’s Allergy Team, The Royal Free NHS Trust. For any further detail on this case study or to connect with Sinéad, please contact england.1professionalvoice@nhs.net