Emanuel Children’s Clinic

1. Emanuel Children’s Clinic Summary of Progress: • Improved optimal asthma care to 72% • Increased the use of a written asthma action plan to greater then 90% through the month of February. March data returned lower scores • Assessing asthma control with a validated instrument and using stepwise approach 100% of the time.

2. EQIPP DATA GRAPHS • Percentage of optimal asthma care. Error in entering flu vaccine data has suppressed this number. • Asthma action plan. Last data cycle shows dip in asthma action plan use.

3. EQIPP DATA GRAPHS • Stepwise approach • Validated instrument

4. Patients 6 mos and older with a recommendation for a Flu Vaccine

5. Clinical Assessment Process Map – Emanuel Children’s Clinic Rooming nurse/MD huddle at the start of each shift to identify patients needing asthma encounter form Nurse gives front Desk staff the encounter form To be handed out To parents at check in Office Visit - Prework Concern: Asthma action plan not always initiated or Updated Plan: RN staff will now place Blank asthma action plans on All charts ID with asthma PDSA Office Flow Diagram Completed form placed into collection folder for later data entry Nurse collects form enters patient information into EMR MD uses stepwise Approach. Adjust medication As needed Asthma action plan Filled out Referral to spirometry As needed. Flu vaccine discussed Asthma Education Provided Form complete At time of rooming Concern:Limited time for MD to provide education Plan: RN’s Will educate families and give handouts. PDSA During Office Visit Physician collects Form enters data Into EMR Form incomplete At time of Patient rooming Nurse schedules spirometry Provides education and Handouts as ordered From MD. Administer flu shot if ordered Concern: Same day appointments Not ID with asthma During morning huddle PDSA Nurse uses Medication List to ID Asthma Pt. RN gives encounter form to family Post Visit Activities All necessary information on the form is entered into EQIPP Clinic data shared with Physician team during monthly meeting EQIPP Data reviewed by physician leader And Nurse supervisor Complete Nurse Supervisor Or Administrative office assistant Collects encounter form and verifies for completeness physician fills out the remainder of form Concern:Data incorrectly Entered for FLU When advised but not Given Plan: Admin Assistant Will correctly enter Data into EQIPP Changes Identified during physician meeting are tested using PDSA and implemented during next collection period Incomplete

6. Plan Plan Plan Do Do Do Plan Do Act Act Act Act Study Study Study Study PDSA Ramp

7. Plan Plan Plan Do Do Do Plan Do Act Act Act Act Study Study Study Study PDSA Ramp

8. Key Learning • Quality improvement starts with small changes. • Learned about PDSA cycles • Registry is necessary for optimal asthma management. • Takes the entire team’s buy-in to successfully make improvements. • Due to compliance would be most beneficial to complete spirometry during clinic visit.

9. Future Plans • Spirometry in clinic • Grant written to obtain spirometry. Grant was successful. Clinic will obtain new machine and training this spring. This will allow us to complete spirometry at the time of appointment. Increase family compliance. • Registry • Clinic developing new EMR “EPIC” with some registry functions? • Currently working on excel spreadsheet. • Education • Nurses will be main asthma educator for family and patients. Developing new handouts. Providing educational in-service for RN staff with MD.