Team Membership Dee Kaupie RCP, AE-C, NPS Michael Wall, PharmD Kathleen Webster, MD

1. Children's Asthma Care Core Measures Follow -Up Team Membership Dee Kaupie RCP, AE-C, NPS Michael Wall, PharmD Kathleen Webster, MD Lindy Champa, RN Confidential: Quality Improvement Material

2. Aim Statement • To improve the quality and efficiency of care • To provide education for all pediatric patients with the primary diagnosis of asthma • To utilize evidence based medicine and to be prepared for core measures • To meet 100% compliance with each of the JCAHO instituting Core Measures for Asthma • Use of Bronchodilators (relievers) • Use of Steroids (controllers) • Home Management Plan of Care (HMPC) specific to the patient Confidential: Quality Improvement Material

3. Background • Most common childhood chronic illness • 4-5 million children in the U.S. suffer from asthma • 200,000 admissions in the U.S. annually • 3 billion dollars in healthcare cost per year Confidential: Quality Improvement Material

4. Promoting Awareness • Imagineif you experienced shortness of breath from simply being outside, changes in weather, exposures to animals, pollen, dust, molds… • Imagine what “takes your breath away” as not the experience of awesome beauty…but a frightening asthma attack Confidential: Quality Improvement Material

5. Bronchospasm Restricts Exhalation Airway Tightness Hurts Action • Taskforce commissioned by senior executives to standardize care and enhance quality for DRG 98 (Asthma, Bronchitis < 17 years old) • Multidisciplinary taskforce assessed current evidence in practice • Developed standardized order set for children2 through 17 years old whose primary reason for admission was asthma • Dee Kaupie, Neonatal/Pediatric Respiratory Care Coordinator, became certified as an Asthma Educator to provide standardized asthma education for Pediatric In-Patients given by MDs, RCPs & RNs Confidential: Quality Improvement Material

6. Implementation of Standard of Care • Standardized order set implemented in Epic • Asthma Action Plan (HMPC) was developed and implemented via Epic • Standardized patient/family education in the proper self-care steps they should take in living with their asthma Results: • Efficiency • Core measure outcomes • Bronchodilators (Reliever Medications) received during hospitalization • Corticosteroids (Controller Medications) received during hospitalization • HMPC as a separate document, specific to the patient and present in the medical record that contains the five core measure components: Use of Reliever medications, Use of Rescue medications, Avoidance of environmental triggers, Written information indicating when to take action, what specific steps to take, and contact information to be used, when an asthma attack occurs or is about to occur, Appointment for follow-up care with a healthcare provider has been made • Given to the patient/caregiver, prior to or upon discharge Albuterol Steroids Trigger Avoidance Home - Management Asthma Action Plan Confidential: Quality Improvement Material

7. Definition: Asthma inpatients under 18 years with documentation in the hospital record that inhaled relievers were provided during hospitalization / all Asthma inpatients under 18 years. Datasource: Original data extracted from LUMC charts by neonatal / pediatric respiratory care practitioner. Analysis: LUMC performance has been at 100% since July 2007. Confidential: Quality Improvement Material

8. Definition: Asthma inpatients under 18 years with documentation in the hospital record that systemic (oral, intravenous, or intramuscular) corticosteroids were provided during hospitalization / all Asthma inpatients under 18 years. • Data source: Original data extracted from LUMC charts by neonatal / pediatric respiratory care practitioner. • Analysis: Corticosteroids were missed for one patient in September 2007. This case has already been reviewed and feedback provided to clinicians. Confidential: Quality Improvement Material

9. Conclusions • Meeting goal for bronchodilators (relievers) and steroids (controllers) • Asthma Action Plan improvement: • Identification of formatting issues and improvement made to the HMPC template in EPIC. • Teaching tool developed for the pediatric residents to refer to in order to understand what the core measures are and where to locate and document the HMPC in EPIC. • Develop universal Asthma Action Plan that can be used in the inpatient, the emergency department and the primary care centers. • Continue orientation of Asthma Education to new pediatric residents • Monitor the effectiveness of the asthma education by researching patient data. • No matter who, what or where • Every living being shares • In the rhythm of breathing • The free flowing tide ofair Next Steps Confidential: Quality Improvement Material