ASTHMA PROGRAM UPDATE Fall 2012

1. ASTHMA PROGRAM UPDATE Fall 2012 South Shore Hospital Jesslyn Murphy, MHA, RRT-NPS, C-NPT, AE-C

2. Federal Action Plan to Reduce Asthma Disparities Strategy 1: Reduce barriers to the implementation of guidelines based asthma management. Strategy 2: Enhance Capacity to deliver integrated, comprehensive asthma care to children in communities with racial and ethnic asthma disparities Strategy 3: Improve capacity to identify the children most impacted by asthma disparities. Strategy 4: Accelerate efforts to identify & test interventions that my prevent the onset of asthma among ethnic & racial minority children.

3. Community Outreach • School RN education and CEUs • 7 Presentations, 170 School RNs • 5,131 Asthmatics (34,349 Students) • Daycare provider education • Health Fares • Professional Education • Youth Health Connection • Physician group presentations

4. Community Involvement • Asthma Regional Council (ARC) • Massachusetts Asthma Action Partnership (MAAP) • Research • CHNA 22 Panelist • Community Benefit Payments

5. Community Support • Spirometry Grant • Harold Brooks Foundation Grant

6. Charlie Arienti Director, Resp. Care & Clinical Engineering Jesslyn Murphy, RRT Project Manager Cindy Cookson, RRT NHP Tammy Ryan, RN Director, VNA Kathleen Petersen RN Manager, VNA Linda Barros Mgr. Healthy Homes Program CHNA 22 Represenative Mark Waltzman, MD Medical Director Michelle Solari, RN VNA TBD Patient / Family Advisor Greg Cardello, MD Pediatric Hospitalist Carol Altonen, NNP VNA Kim Noble VNA, YHC Jeremy Warhaftig, MD SSMC MD RNs VNA PCH Division Geraldine McNamara Medical Perf. Mgmt. Director Beth Klements, PNP CHB Asthma CNS

7. Progress • In-Patient Albuterol Protocols • Comprehensive education • Asthma Action Plans • Asthma Classification Tests • Community Outreach • BAA with Self Help, Inc. • ER Triage RN Driven Albuterol

8. Home Bases Environmental Interventions: Spectrum of Intensity Examples of Interventions Source: CDC Task Force on Community Preventative Services. “Asthma Control: Home-Based Multi-Trigger, Multicomponent Environmental Interventions Summary Evidence Tables – Economic review:

9. Science  Evidenced Based Practices • Use Inhaled corticosteroids • Use written Asthma Action Plans • Assess asthma severity • Assess and monitor asthma control • Schedule follow-up visits • Control environmental exposures

12. HASS Based Orderset SEVERE ASTHMA MANAGEMENT: HASS SCORE = 10-15 • Consult to Inpatient Pediatric Hospitalists • Consult to Pedi/NICU RT via page • 3 stacked Albuterol/Ipatroprium nebs • Corticosteroids CONSIDER: • Continuous Aerosolized Bronchodilator • Oxygen as indicated • Heliox • EtCO2 • Magnesium • Terbutaline • Score q 30 minutes MODERATE ASTHMA MANAGEMENT: HASS SCORE = 7-9 • Consult to Pedi/NICU RT via page CONSIDER • 3 stacked Albuterol/Ipatroprium nebs • Systemic corticosteroids • Oxygen as indicated • Score q 1 hour MILD ASTHMA MANAGEMENT: HASS SCORE = 5-7 CONSIDER • Nebulizer therapy • Oxygen as indicated • Score q 1-2 hours

13. Readmissions # of Patients

15. Monitored Parameters Transfers Decompensation Education Asthma Action Plan Town Insurance PCP & Practice • Admitting Diagnosis • ED Priority • LOS • ED & Adm. HASS • SABA Times • Order • Override • Delivery • Steroid Time • Door to Admit • Admit to Floor

16. FY2012 Metrics

18. Goals

19. What Still Needs To Be Done • Increase efficiency • E.g. Triage RN Initiated Albuterol Protocol • Improve awareness • Internally & Externally • Joint Commission disease specific accreditation for asthma

21. Net Annual Loss $- 4,283,604 Information per SSH FY12 Finance Report provided by Dan Tenaglia