A Program for Asthma Education in an Urban Level I Trauma Center Christine A. Kletti, MD FACEP Hennepin County Medical Center Program #2078

Asthma Education in an ED ED’s provide asthma care to an increasing number of patients Asthma exacerbations often result of… –Lack of understanding about disease –Poor asthma management skills –Lack of consistent primary care –Lack of access to primary care Program # 2078

Asthma Education in an ED Goal Develop asthma education program for patients seen in the ED for asthma symptoms that will improve patients’ asthma self-management skills Program # 2078

Asthma Education in an ED Asthma self-management requires –Understanding of disease process –Ability to identify symptoms –Knowledge of medications and indications –Appropriate technique for medication administration –Understanding of importance of consistent primary care Program # 2078

Asthma Education in an ED Opportunities for Education in the ED –“Teachable Moment” Patients may be more receptive to education during an exacerbation –Time to teach during treatments while being observed for response Program # 2078

Asthma Education in an ED Barriers to Education in our ED –Lack of time by ED staff due to High acuity of patients –Inner city Level I Trauma Center Lack of predictability of patient arrival –Language barriers –Lack of patient receptiveness Program #2078

Asthma Education in an ED Curriculum characteristics for success –Limited number of messages –Simple, concise teaching points –Varied methods of disseminating information –Limited additional requirement of staff time Program # 2078

Asthma Education in an ED Program characteristics for success –Well developed curriculum –Delivered throughout patient stay –Initiated with RN or medical provider order in electronic health record –Frequent reminders/refreshers for staff Program # 2078

Asthma Education in an ED Program Development Multidisciplinary team –EM physician –Pulmonologist –Nurses –Asthma education specialists Program # 2078

Asthma Education in an ED Components of Asthma Curriculum 1.Face to Face teaching 2.Video 3.Asthma Education Booklet 4.Written Discharge Instructions Program #2078

Asthma Education in an ED 1. Face to Face Teaching Explain indication for medications Difference between “controllers” and “relievers” Medication administration technique Demonstrate spacer/ inhaler technique Request teach back Interpreters to facilitate as needed Program #2078

Asthma Education in an ED 2. Video Describes symptom recognition Demonstrates asthma self-management skills Available in –English –Spanish –Somali –Hmong Suggest playing video during treatment Program #2078

Asthma Education in an ED 3. Take Home Asthma Booklet –More thorough coverage of asthma –Available in English and Spanish 4. Written Discharge Instructions –Emphasis on importance of follow up with a primary care provider Program # 2078

Asthma Education in an ED Review of the program Retrospective chart review reveals –30% of asthma patients are receiving asthma education in our ED Post discharge survey reveals –Patients satisfied with program –Patients felt it was useful Program #2078

Asthma Education in an ED Asthma education can be successfully delivered in a busy ED 1.Curriculum should consist of limited, concise messages be available in multiple languages 2.Deliver education throughout the ED visit 3.An order to initiate the education may increase rate of delivery 4.Frequent reminders/refreshers required

Asthma Education in an ED Special Thanks to Gail Brottman, MD Angie Carlson, PhD Sherry Murphy, RN Cherylee Sherry, MPH, CHES Program #2078