2004 OPEN FORUM Abstracts
RESPIRATORY THERAPISTS (RT’S) INTEGRAL ROLE OF ASTHMA MANAGEMENT IN THE EMERGENCY DEPARTMENT (ED)
Rhonda Vosmus, RRT, NPS, AE-C,
Maine Medical Center, Portland, ME
BACKGROUND:
Respiratory therapists (RT’s) are one of the first
healthcare providers to come in contact with an asthma patient in the
Emergency Department (ED) at Maine Medical Center (MMC). The RT
assesses treats and creates an action plan for asthma patients. Prior
to the AH! Asthma Health Program educational intervention, there was
no consistent patient education, patient educational materials were
scarce and there was no tracking mechanism for follow up of asthma
patients utilizing the ED.
METHOD: We provided asthma
education and a skill testing for all seventy-four RT’s at MMC.
Patients who received nebulized medication in the ED were asked two
questions. “Have you been diagnosed with asthma in the past?”
and “Are you on inhaled steroids?” If the patient or
family member answered yes to either question the RT shared five
basic asthma messages. (1) Asthma is a chronic inflammatory
disease (2) There are two types of medicines to treat
asthma: controller and quick relief (3) Triggers can make your
asthma worse (4) Monitor your symptoms, and (5)
Asthma plans and regular visits to your healthcare provider
can help control your asthma. The RT and ED physician developed
and reviewed a written emergency asthma plan with the patient/family
and gave them a brochure, which listed additional educational
resources. The asthma educator reviewed a copy of the emergency
action plan and provided telephone follow up.
RESULTS: During
the eighteen-month period from September 2002 to March 2004, 322
emergency asthma plans were written. This was a 100% increase in
written plans prior to the educational intervention. In addition,
(7%) patients were identified as not having a primary care provider,
(12%) patients were eligible for uncompensated care and were enrolled
in appropriate assistance programs (i.e., out patient clinics,
Medicaid, pharmaceutical drug programs), (39%) patients/families were
provided with education by telephone, and (12%) patients scheduled a
follow up appointment with an asthma educator. We also sent a mailing
to (30%) patients who could not be reached by telephone, but were
still unsuccessful in reaching them.
EXPERIENCE: We found
patients and families were receptive to follow up telephone
conversations about their asthma. Limitations included phone numbers
that were not always current in electronic medical records and
workloads that often restricted the availability of education in a
level one-trauma center.
CONCLUSION: Written plans are helpful
tools to track ED asthma utilization. Reinforcement of basic asthma
messages by the health care team is an essential part of our
partnership with the patient and family. Patients with financial
constraints were connected to assistance programs and patients
without a provider were connected with our clinics, thus reducing the
impetus to use the ED as their primary place of care. Positive
outcomes resulting from this process improvement project are
encouraging, more specific follow up data after intervention maybe
helpful in showing reduced ED utilization for asthma management. The
RT’s at MMC have been given a more active role in collaborating
with asthma management and have self reported enhanced job
satisfaction.