The Online Newsletter for Children's Nurses
e-Edition, Issue 9
Striving for Excellence in Children's Asthma CareBy Donna Wesenberg, BSN, RN, CPN
In 2007, counties served by Children's Hospital Central California had much higher rates of hospitalization for asthma in children age 14 and under when compared to other California counties (see chart). This could possibly be attributed to the large number of allergens from agriculture and pollution. There are five Central Valley metropolitan areas identified within the top ten with the worst year-round particle pollution in the nation as reported in the “2011 State of the Air” report. They are: Bakersfield-Delano (#1), Visalia-Porterville (#2), Hanford-Corcoran (#5), Fresno-Madera (#6) and Modesto (#10).1
Because the population Children’s serves is particularly vulnerable to asthma exacerbations, staff need to provide them with the best care and education. A review of literature shows multiple studies in which asthma education that includes a written action plan reduces the number of emergency department visits and hospital admissions by 22-50 percent.2 National Institutes of Health (NIH) asthma guidelines emphasize the need for asthma self-management education at multiple points of care, including the hospital, and recommends that everyone with asthma have an asthma action plan.3 However, the 2009 United States National Health Interview Survey revealed only 44 percent of children with asthma received an action plan.4
Beginning in 2007, the Children’s Asthma Care (CAC) measure sets, which are based on NIH asthma guidelines, were initiated at Children’s. Reports are sent quarterly to The Joint Commission. Children’s has performed well with the CAC measures, which verify that asthma relievers and systemic corticosteroids are used during hospitalization for asthma. Results demonstrate 96-100 percent compliance since 2007. An additional CAC measure evaluates the use of the Asthma Home Management Plan of Care (AHMPoC) which includes an asthma action plan.
The elements in the AHMPoC include:
1) A copy must be retained in the patient’s permanent chart with documentation that it was given to the patient/caregiver
2) A follow-up appointment with the primary care provider or a pulmonary specialist (or the clinic phone number and time frame by which the appointment needs to be completed) must be provided to the patient/caregiver
3) The patient/caregiver must be instructed on controlling environmental and other asthma triggers
4) The patient/caregiver must be instructed on methods and use of controller and reliever medications when asthma symptoms worsen.5
The CAC task force was organized to address the importance of keeping Children’s asthmatic population healthy. The result was the creation of an action plan that encouraged interdisciplinary collaboration with nursing, respiratory and medical staff in ensuring all patient/families receive the AHMPoC. Since the action plan was implemented, Children’s has seen an increase in the use of the asthma home management plan of care. Apollo nurses shared their success by presenting a poster during national nurses’ week observance at Children’s in May of 2011. The CAC taskforce has worked with the advanced clinical systems (ACS) build team to include the required CAC measure components in the electronic version of the AHMPoC.
The focus on quality patient care remains consistent as the interdisciplinary team continues to ensure patients and their families receive the education needed to manage their asthma.
1 American Lung Association (2011). State of the Air. http://www.stateoftheair.org/2011/city-rankings/most-polluted-cities.html
2 Andrade, W., Camargos, P., Lasmar, L., & Bousquet, J. (2010). A pediatric asthma management program in a low-income setting resulting in reduced use of health service for acute asthma. Allergy, 65(11), 1472-1477. doi:10.1111/j.1398-9995.2010.02405.x; Davis, A., Benson, M., Cooney, D., Spruell, B., & Orelian, J. (2011). A matched-cohort evaluation of a bedside asthma intervention for patients hospitalized at a large urban children's hospital. Journal of Urban Health: Bulletin of The New York Academy of Medicine, 88 Suppl 149-60.
3 National Institutes of Health & National Heart, Lung, and Blood Institute (2007). Expert panel report 3: guidelines for the diagnosis and management of asthma. Bethesda, MD: US Department of Health and Human Services, National Institutes of Health, National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf.
4 National Center for Health Statistics (2010). National Health Interview Survey (NHIS) 2009 data release. Atlanta, GA: US Department of Health and Human Services, CDC, National Center for Health Statistics. http://www.cdc.gov/nchs/nhis/nhis_2009_data_rel≥≥ease.htm.
5 The CMS/Joint Commission (2010) Children’s Asthma Care. Specification Manual for National Hospital Inpatient Quality Measures. Version 3.2 http://www.jointcommission.org/specifications_manual_for_national_hospital_inpatient_quality_measures/
In This Issue
A Recipe for Advanced Clinical Systems
Code of Ethics for Nurses
Champions… A Key to Success
Optimizing the Wound Healing Environment
The Pace of Regulatory Change
Alphabet Soup in the Ambulatory Division
Shared Governance: PICU Skin Care Program
Striving for Excellence in Children's Asthma Care
Patient Satisfaction Comments