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Chapter Quality Network Asthma Pilot Project Team Progress Presentation

Chapter Quality Network Asthma Pilot Project Team Progress Presentation. Alabama AAP Chapter University Medical Center Heather Taylor, Beth Smith, Cindy Hannah. Progress Summary Since Learning Session 1. Adapted Encounter Form and used stepwise approach until all providers using form

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Chapter Quality Network Asthma Pilot Project Team Progress Presentation

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  1. Chapter Quality Network Asthma Pilot ProjectTeam Progress Presentation Alabama AAP Chapter University Medical Center Heather Taylor, Beth Smith, Cindy Hannah

  2. Progress Summary SinceLearning Session 1 • Adapted Encounter Form and used stepwise approach until all providers using form • Developed and implemented protocol for distribution of encounter forms • Developed protocol for phone triage of asthma patients, med refills, and follow-up visits • Designed/tested/implemented simplified Asthma Action Plan (English version; now testing Spanish version) • Building teaching resources (posters, inhaler demonstrators, parent/patient handouts)

  3. EQIPP Graph 1 • % of patients with optimal asthma care

  4. EQIPP Graph 2 • % of patients in which validated instrument was used to determine current control

  5. EQIPP Graph 3 • % of patients in which stepwise approach is used

  6. EQIPP Graph 4 • % of patients with flu shot recommendation

  7. EQIPP Graph 5 • % of patients with written asthma action plan

  8. PDSA Cycles • PDSA Title: Use of Encounter Form in Clinic • Plan: Have nurse give form to patient to fill out at time of triage • Do: Initially tested process with only Beth and Heather’s patients; then spread clinic-wide • Study: Discovered problems with double-sided format, font size, patients filling out MD section • Act: Created 2-page form and placed it on nursing desktops so it could be printed out, made adjustments in font size; plan to incorporate MD section in new EHR template

  9. P P P D D D S S S A A A PDSA Ramps: Use of Encounter Form Test 3 What: Using 2-page form Who: Patients/Providers Who (executes): All providers Results: Less patients fill out MD section when given specific instructions; all providers using form Test 2 What: Using 2- page form Who: Patients/Providers Who (executes): Beth, H Taylor Results: Less patients filling out MD portion (though still occurring); works better to print from desktop Test 1 What: Using double-sided form Who: Patients/Providers Who (executes): Beth, H Taylor Results: Patients filled out both sides of form; nurses found it easier to print form from desktop when needed

  10. P P P D D D S S S A A A PDSA Ramps: ID of Asthma Patients Test 3 What: ID of asthma patients Who: Clinic team Who (executes): Everyone Results: Established protocol for who gets form and when; works well unless student nurse or floater nurse is putting patients back Test 2 What: ID of asthma patients Who: Clinic team Who (executes): Beth, Cindy Results: Went through schedule day before and tagged asthma patients; worked well unless they were out/busy/forgot Test 1 What: ID of asthma patients Who: Clinic team Who (executes): Beth, H Taylor Results: Queried EHR for list; started going through list and tagging patients in electronic chart; too tedious – didn’t get far

  11. Office Flow Diagram Asthma Patients ID’d by placing “sticky note” in EHR (day before) or by nurse review of diagnosis list (at time of visit) Nurse gives form to parent to fill out after getting vital signs Parent fills out form while waiting for MD During the visit, MD discusses form with parent/patient Information is entered into EQIPP by provider at earliest convenience MD enters parent answers into EHR; fills out MD section of form Not all patients getting forms Parent answers not getting recorded in EHR; MD not completing provider section Form is scanned into EHR Forms being held by providers

  12. Key Learnings • It is essential to QI project success to have group buy-in from the beginning. • Have to have protocol/process for orienting new staff, residents to asthma project.

  13. Barriers and Successes • Barriers • Time! • Tight resources – in terms of both staff and funding • Staffing changes • Successes • Patients have seemed to really appreciate the new action plans, new education push • Nurses feel better prepared to handle triage calls from asthma patients • Residents feel better prepared to take care of asthma patients • Everyone is now on the same page in terms of our asthma patients

  14. Future Plans • Spirometry • New EHR • Expanded education resources

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