The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

SIGNIFICANT DECREASE IN UTILIZATION SEEN AFTER INSTITUTION OF ASTHMA HOME CARE PLAN

Anne E. Kwiatkowski; Respiratory Care, St. Vincent Mercy Medical Center, Toledo, OH

Background The Joint Commission and the Children’s Asthma Care advisory panel recommended three core measures to be implemented nationwide to address the lack of hospital performance measures relevant to children’s asthma healthcare. These core measures are: reliever medications administered, systemic corticosteroids administered, and a home management plan addressing: Use of controllers/relievers Triggers Timing of rescue actions Patient/Caregiver signature Appointment made with primary care physician (or pulmonologist) for follow-up after discharge A copy of the plan placed in the chart and a copy given to the caregiver St. Vincent Mercy Medical Center/Mercy Children’s Hospital adopted these core measures. Prior to implementing these standards, our compliance with asthma education was 11%. Methods Our hospital instituted a pathway to manage asthmatics in 1994. This increased our consistent use of medications, both relievers and controllers, from 12% to 96%. Our written plan contains all of the required information. Included on this form is a section addressing symptoms and/or peak flows and the appropriate response. It is color coded in the stoplight format. The family receives asthma education both oral and written during their admission. The asthma educator provides and reviews the completed plan with the parents upon discharge. In the educator’s absence the plan is given to the family by the respiratory therapist or nurse. We explored utilization of 157 children that received the plan upon discharge from the hospital. Results Our asthma education and discharge controller medications have improved from 12% to 96%. Of the 157 children that received a plan, 79 had ER visits and/or hospitalizations prior to this particular admission. ER visits included the diagnoses of asthma, URI, viral infection, cough, wheezing, bronchitis and respiratory abnormalities. After receiving the plan, only 23 had repeat utilization in the ER or as an inpatient. Conclusions Our institution’s compliance has increased dramatically for using an action plan, and for patients being discharged on controller medications. Our plan is neither revolutionary nor experimental. We are simply consistently applying what we know works. Can having an asthma action plan in place impact future ER and/or hospital utilizaion? This is something that has yet to be determined. However based on our findings, it appears that having a plan coupled with education is certainly beneficial. Sponsored Research - None

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