Shauna McKibben

Project: Feasibility and impact of implementing electronic flagging alerts of bronchodilator overuse in primary care

People with asthma who rely on their bronchodilator (quick reliever) and not the preventive inhaler, which tackles the root cause of asthma often have poor control of their disease. Many studies confirm that they are at increased risk of asthma attacks, hospital admission and even death. Expert reviews have shown that many people who died from asthma had not only received many bronchodilator inhalers (often more than 20 inhalers/year) from their GP but also had not been invited to, or had not attended, an asthma review to discuss their inhaler use and asthma control.

Current GP computer prescribing systems do not effectively flag up overuse of bronchodilator inhalers. An effective flagging system is urgently needed to identify and target such people at high risk of asthma attacks by triggering an invitation to a review.

This PhD takes forward our work on bronchodilator overuse: the researcher will start by interviewing asthma experts (including people with asthma) and general practice teams to identify the important features of a flagging system that general practices will use, and how they will respond to the alerts. They will then work with EMIS (the UK’s leading provider of GP software) to develop such a system. They will pilot its implementation in four general practices, examining how practices use the system and whether it effectively triggers effective asthma reviews, to determine whether we can measure the impact of the flagging system in a larger, definitive study.

About me

Shauna qualified in adult nursing from Queen's University, Belfast, graduating with the Professor Sheila Harrisson Prize for Academic Excellence in Adult Nursing. She started her clinical career at the Royal Brompton Hospital, London and has held clinical posts in cardiothoracic surgery, respiratory and allergy across secondary care, tertiary care, and the charity sector. In 2020 she was awarded a PhD in Primary Care and Public Health.

Since completing her PhD, Shauna works as Clinical Nurse Specialist (Allergy and Asthma) at Imperial College NHS Trust, London. She is the Patient and Public Involvement and Engagement Lead for the NIHR Imperial Respiratory Biomedical Research Centre (BRC). She is the first nurse editor of the Allergy Update: the official newsletter of the British Society for Allergy & Clinical Immunology (BSACI), and is a member of the Nurses in Allergy Committee.

She is currently undertaking a PG Cert in Allergy at Southampton University. Her interests include allergic rhinitis, drug allergy, asthma, patient experience and self-management, and improving allergy management across primary and secondary care. 

Publications

1. Savic L, Ardern-Jones M, Avery A, Cook T, Denman S, Farooque S, Garcez T, Gold R, Jay N, Krishna MT, Leech S, McKibben S, Nasser S, Premchand N, Sandoe J, Sneddon J, Warner A. BSACI guideline for the set-up of penicillin allergy de-labeling services by non-allergists working in a hospital setting. Clin Exp Allergy. 2022 Oct;52(10):1135-1141. doi: 10.1111/cea.14217. Epub 2022 Sep 21. PMID: 36128691.
2. Johnson H, Piggin M, McKibben S, Davies J, Chilvers E. Insight Report: Respiratory Medicine Research Prioritisation Online Survey. NIHR Imperial Biomedical Research Centre. 2021. doi:10.25561/94140.
3. McKibben S,  Bush A, Thomas M, Griffiths C. “I don’t think there’s a simple way of doing it:” the use of an electronic alert to identify excessive prescribing of short-acting beta2-agonists for people with asthma – a qualitative study with asthma experts and primary care staff [Abstract]. European Respiratory Journal Sep 2020, 56 (suppl 64) 4013; DOI: 10.1183/13993003.congress-2020.4013.
4. McKibben S, Bush A, Thomas M, Griffiths C. An electronic alert to reduce excessive prescribing of short-acting beta2-agonists for people with asthma in East London: a retrospective case-control study using routine primary care data [Abstract]. European Respiratory Journal 2020 56: 1364; DOI: 10.1183/13993003.congress-2020.1364.
5. McKibben S, Bush A, Thomas M, Griffiths C. "Tossing a coin:" defining the excessive use of short-acting beta₂-agonists in asthma-the views of general practitioners and asthma experts in primary and secondary care. NPJ Prim Care Respir Med. 2018 Jul 18;28(1):26. doi: 10.1038/s41533-018-0096-4. Erratum in: NPJ Prim Care Respir Med. 2019 Jan 14;29(1):1.
6. McKibben S, De Simoni A, Bush A, Thomas M, Griffiths C. The use of electronic alerts in primary care computer systems to identify the excessive prescription of short-acting beta₂-agonists for people with asthma: a systematic review. NPJ Prim Care Respir Med. 2018 Apr 16;28(1):14. dot:10.1038/s41533-018-0080-z.
7. Hull SA, McKibben S, Homer K, Taylor SJ, Pike K, Griffiths C. Asthma prescribing, ethnicity and risk of hospital admission: an anaylsis of 35,864 linked primary and secondary care records in East London. NPJ Prim Care Respir Med. 2016 Aug 18;26:16049. doi: 10.1038/npjpcrm.2016.49.
8. Preventative respiratory disease [Chapter 8] and Epidemiology and contributing factors [Chapter 9]. McKibben S. In W. Preston and C. Kelly (Eds.), Respiratory Nursing at a Glance, 2016 (pp. 14-18). Wiley Blackwell. ISBN: 978-1-119-04830-5.
9. Noble, H & McKibben, S 2014, ‘AKI hits the headlines: let’s blame the nurses..’ British Journal of Nursing, vol 23, no. 9, pp. 452. https://doi.org/10.12968/bjon.2014.23.9.452

Acknowledgements

Funded by Queen Mary University of London