CHAT Asthma Collaborative

1. Safety and Quality Collaborative CHAT Asthma Collaborative

2. CHAT Safety and Quality Collaborative Objectives: To describe fundamental tenets of quality improvement To demonstrate ways to demonstrate quality improvement data To describe evidence based approaches to the diagnosis and management of pediatric asthma To discuss the CHAT safety and quality collaborative purpose, design, and implementation in the ED and Inpatient unit

3. CHAT Safety and Quality Collaborative Introduction: Partnership of 8 children’s hospitals in Texas Goals of the collaborative: To improve the quality and safety of care in CHAT hospitals To evaluate and establish the process for the development and adoption of evidence-based pathways To improve the care for ED and inpatient pediatric asthma To demonstrate improved outcomes of care with decrease cost of care delivery

4. CHAT Safety and Quality Collaborative Rationale: Standardization of practice within an institution will improve efficiency and effectiveness of care Standardization of practice throughout the CHAT hospitals will allow for aggregate learning, economies of scale in data management, and acceleration of discovery for best practices Rapid cycle improvement will occur in multiple cycles

5. CHAT Safety and Quality Collaborative Key Elements of Evidence Based Pathway Recommendations Recommendation:   Strong recommendation with good quality evidence that corticosteroids speed the resolution of airflow obstruction, reduce the rate of relapse, and may reduce hospitalizations, especially if administered within one hour of presentation to the ED. Oral prednisone has effects equivalent to those of intravenous methylprednisolone Dexamethasone is as effective as  prednisone

6. CHAT Safety and Quality Collaborative Key Elements of Evidence Based Pathway Recommendations Cont. Evidence For Recommendation: Strong recommendation with high quality evidence for the use of ipratropium bromide with beta agonist for three doses as adjunct therapy in children with moderate – severe asthma exacerbations. Recommendation: Strong recommendation with moderate quality evidence for the use of IV magnesium sulfate as adjunct therapy when there is inadequate response to conventional therapy within the first hour in children with moderate to severe asthma exacerbations. Recommendation: Strong recommendation with low quality evidence for the use of non-invasive positive pressure ventilation prior to intubation in children with severe asthma exacerbations.

7. CHAT Safety and Quality Collaborative Key Elements of Evidence Based Pathway Recommendations Cont. Evidence Against Evidence Against: Routine use of Spirometry or Peak Flow, ABG/VBG, CXRto determine level of severity. Not Recommended: Low quality evidence to use Heliox in the treatment of children with asthma exacerbations. Not Recommended: Low-quality evidence to use subcutaneous terbutaline or epinephrine with severe asthma exacerbations. Evidence Inconclusive Level of oxygen saturation to start or wean supplementation β agonist weaning regiment Discharge criteria Use of asthma score Initiating controllers in ED/inpatient

8. CHAT Asthma Best Practices Matrix

9. CHAT Asthma Best Practices Matrix Cont.

10. CHAT Asthma Best Practices Matrix Cont.

12. CHAT Safety and Quality Collaborative Should you have any questions, please refer to (please insert: Name/ email/ phone number of the specific person (s) at each institution), your assigned resource / educator

13. CHAT Safety and Quality Collaborative Before and after this training, you will be asked to complete a brief assessment to determine your acquisition of knowledge

14. CHAT Safety and Quality Collaborative Questions