1. Big Swamp Wheezers O P E L I K A - A U B U R N

2. SmalleyJonesAnzNicholsSmith TYoung GlazeN.CarterM.CarterFullerWilliamsTaylor physicians

3. Big Swamp Wheezers Team Members Dr. Linda AnzLeigh Ann BrogdonSummer Galloway Licensed Practical Nurse Front Office ManagerPhysician

4. Opelika – Auburn MSA The Opelika-Auburn Metropolitan Statistical Area (MSA) is Alabama’s newest and fastest growing MSA. Comprised solely of Lee County, the Opelika-Auburn MSA’s population grew by 32% from 1990 – 2000. Our growth ranks 19th nationally among all MSA’s. Opelika named one of the top six places to retire by Kiplinger’s Magazine. Auburn named to U.S. News & World Report’s list of the Best Places to Live 2009

5. Pediatric Clinic, L.L.C. Founded in March 1968 by Dr. B. D. Curry. Physician-owned medical clinic serving Lee and surrounding counties in the East Central Alabama and West Georgia region. Open every day of the year. Regular Office Hours - Monday through Friday 8 a.m. to 5 p.m After-hours Clinic - Monday through Friday 5 p.m. to 9 p.m. / Saturdays 8 a.m. to 5 p.m. / Sundays & Holidays 12 p.m. to 5 p.m.

6. Team Aim Statement Standardization of patient care Quality Improvement in the Office Setting Achieve measurable improvement in asthma outcomes within our clinic Providing optimal care to our asthma patients To have greater than or equal to 90% of our patient’s asthma well controlled

7. Interventions And Changes Diagnosing asthma by using the asthma key indicators Recommendation of flu shots to all of our asthma patients Restricting the refill of asthma medicines unless patient has had an asthma recheck within the last three months Giving asthma education handouts, as well as, having the nurses show the parents and patients the proper use of their inhalers Identifying all of our asthma patients by labeling their charts and keeping an Excel list of them Asthma Action Plans

8. Unable to ID Asthma patients at front desk Having nurse to ID and give encounter form before MD enters room Pediatric Clinic, LLC Asthma Flow Sheet Opelika, Alabama Asthma Patients identified by nurse during office visits. If sick visit, nurse tags the chart with blue sticker to reflect “asthma patient” and adds patient to “asthma log”. At Office visit nurse gives an encounter form to parent for completion. Tags the chart with blue sticker to reflect “asthma patient” and add patient to “asthma log”. If AfterHour clinic or a busy day with multiple patients waiting, Doctor will evaluate and treat patient for present illness. Doctor examines patient, fills out Asthma Action Forms and adjust medicines if needed. Doctor fills out prescription and Asthma Action Plan if needed. Nurse copies Asthma Action Form and provides patient education if needed. Nurse copies Asthma Action Plan for chart copy. Patient discharged to check out with orders to make an asthma recheck visit with appropriate time slot. Patient is discharged to check out with orders to make an appointment for an asthma recheck with appropriate time slot. Doctor gives completed encounter form and chart to nurse. Having the nurse keep the asthma log: Excel log

9. OFFICE FLOW WEAK POINTS Our front office staff is not able to identify our asthma patients for our back staff Having the nurses identify the asthma patient and giving the encounter form before the Dr. enters the room for the exam Making sure that the nurses are putting the names on our Excel list

10. Our Asthma Action Form WILL BE ADDED BY THE TIME WE GET THERE….FINGERS CROSSED!

11. Our Encounter Form Will be added by the time we get there

12. Our Excel Patient Log Sheet Will be added by the time we get there

13. Percentage of patients with optimal asthma care

14. Percentage of patients with key asthma indicators used when considering an asthma diagnosis

15. Percentage of patients ages 5 and older where spirometry is scheduled to be tested or results have been obtained within the last 1-2 years

16. Percentage of patients in which a validated instrument is used to determine the current level of asthma control

17. Percentage of patients who have a current written asthma action plan explained to them at this visit

18. Percentage of patients with asthma ages 6 months and older who have received a flu shot or flu shot recommendation within the past 12 months

19. Lessons Learned Twelve different Doctors; twelve different opinions ~RESISTANCE~ Parents LOVE the action plans and education Having the nurse identify the asthma patient prior to the Doctor entering the exam room makes the flow of having the encounter form filled out much more time effiecient

20. ENCOUNTER FORMS PDSA Forms were confusing for some patients and not friendly to enter into EQUIP Decided we would change to suit our needs Adapted Forms were given to three patients during an office visit Dr. Anz to give encounter forms (provided by team) to patients PD SA Patients better understood them, and they were much easier to enter into EQUIP for physicians We adopted the new forms and they are used clinic wide. They are within our EMR for easy access. New forms were given to numerous patients during an office visit To try the newly modified encounter forms on our patients PD SA

21. ACTION PLANS PDSA They were not very thorough and parents didn’t seem to follow instructions Started looking for an AAP that was better for patients Gave to patients at appointment Dr. Anz made an AAP on her computer for patients PD SA Found that the “check box” forms seemed easier to do and for patients to understand All doctors agreed on one AAP; we incorporated it within our new EMR for easy access Printed and tried numerous plans with patients in the clinic setting Find an AAP that all physicians liked PD SA

22. PATIENT EDUCATION PDSA Nurses were very receptive to this and found the meeting to be very helpful Began offering patients education with handouts and demonstrations Had Jennifer meet with nurses. She used all types of equipment and hand outs to teach the nurses education. To hold a meeting with nurses to teach asthma education PD SA Found that they had numerous tools for young and older patients as well as parents Reviewed the tools that were given to us and began to hand out the information that we felt suitable for our patients Asked different drug rep.’s for educational information on asthma for parents and patients To get different educational tools from various resourses PD SA

23. Future Plans Spriometer that interfaces with our new EMR program Building a registry within our EMR program Having our asthma patients perform a base line spirometer at asthma rechecks