Chapter Quality Network Asthma Pilot Project Team Progress Presentation Alabama AAP Chapter University Medical Center Heather Taylor, Beth Smith, Cindy Hannah

Progress Summary Since Learning Session 1 Adapted Encounter Form and used stepwise approach until all providers using form Developed and implemented protocol for distribution of encounter forms Developed protocol for phone triage of asthma patients, med refills, and follow-up visits Designed/tested/implemented simplified Asthma Action Plan (English version; now testing Spanish version) Building teaching resources (posters, inhaler demonstrators, parent/patient handouts)

EQIPP Graph 1 % of patients with optimal asthma care

EQIPP Graph 2 % of patients in which validated instrument was used to determine current control

EQIPP Graph 3 % of patients in which stepwise approach is used

EQIPP Graph 4 % of patients with flu shot recommendation

EQIPP Graph 5 % of patients with written asthma action plan

PDSA Cycles PDSA Title: Use of Encounter Form in Clinic – Plan: Have nurse give form to patient to fill out at time of triage – Do: Initially tested process with only Beth and Heather’s patients; then spread clinic-wide – Study: Discovered problems with double-sided format, font size, patients filling out MD section – Act: Created 2-page form and placed it on nursing desktops so it could be printed out, made adjustments in font size; plan to incorporate MD section in new EHR template

PD SA Test 1 What: Using double-sided form Who: Patients/Providers Who (executes): Beth, H Taylor Results: Patients filled out both sides of form; nurses found it easier to print form from desktop when needed PD SA Test 2 What: Using 2- page form Who: Patients/Providers Who (executes): Beth, H Taylor Results: Less patients filling out MD portion (though still occurring); works better to print from desktop PD SA Test 3 What: Using 2-page form Who: Patients/Providers Who (executes): All providers Results: Less patients fill out MD section when given specific instructions; all providers using form PDSA Ramps: Use of Encounter Form

PD SA Test 1 What: ID of asthma patients Who: Clinic team Who (executes): Beth, H Taylor Results: Queried EHR for list; started going through list and tagging patients in electronic chart; too tedious – didn’t get far PD SA Test 2 What: ID of asthma patients Who: Clinic team Who (executes): Beth, Cindy Results: Went through schedule day before and tagged asthma patients; worked well unless they were out/busy/forgot PD SA Test 3 What: ID of asthma patients Who: Clinic team Who (executes): Everyone Results: Established protocol for who gets form and when; works well unless student nurse or floater nurse is putting patients back PDSA Ramps: ID of Asthma Patients

Office Flow Diagram Asthma Patients ID’d by placing “sticky note” in EHR (day before) or by nurse review of diagnosis list (at time of visit) Nurse gives form to parent to fill out after getting vital signs Parent fills out form while waiting for MD During the visit, MD discusses form with parent/patient MD enters parent answers into EHR; fills out MD section of form Information is entered into EQIPP by provider at earliest convenience Form is scanned into EHR Parent answers not getting recorded in EHR; MD not completing provider section Forms being held by providers Not all patients getting forms

Key Learnings It is essential to QI project success to have group buy-in from the beginning. Have to have protocol/process for orienting new staff, residents to asthma project.

Barriers and Successes Barriers – Time! – Tight resources – in terms of both staff and funding – Staffing changes Successes – Patients have seemed to really appreciate the new action plans, new education push – Nurses feel better prepared to handle triage calls from asthma patients – Residents feel better prepared to take care of asthma patients – Everyone is now on the same page in terms of our asthma patients

Future Plans Spirometry New EHR Expanded education resources