Asthma in a Minute: Tool Kit for asthma self-management education - - PowerPoint PPT Presentation

School Nurses can teach key asthma lessons, one minute at a time

Dottie Bardon, BSN, MEd, RN, NCSN LaSalle Springs Middle School Rockwood School District April 19, 2018

Asthma in a Minute:

Tool Kit for asthma self-management education

Why does it matter? Asthma remains the most prevalent chronic condition affecting students of all ages.

[CDC, 2012]

 Expert Panel Report of 2007, defines the Guidelines for Diagnosis and Management of Asthma  The “gold standard” of asthma care, from the National Institutes of Health, and National Asthma Education and Prevention program  Advocated by Missouri Asthma Prevention & Control Program

[NHLBI, 2007]

What is the EPR3?

 Accepted protocol for asthma care & education  Step-wise medication protocols should guide prescribers  Potentially will be linked to third party re-imbursement

EPR3

1. Measurable assessment of asthma severity 2. Medications prescribed according to a step-wise protocol, emphasizing Inhaled Corticosteroids [ICS] for persistent asthma 3. Control of environmental factors 4. Education of patients

EPR3 Four Main Components:

 Effective education is a partnership between the clinician and the person who has asthma  Self-management improves outcomes [urgent care visits, perceived control of symptoms, quality of life]  Cost-effective use of professional time  Reduces school absenteeism  Every encounter, for every reason, should include some element

• f asthma education

 Repetition and reinforcement are essential

[NHBLI, 2011]

Asthma Education: “teach and reinforce key messages at every opportunity.”

 Basic facts about asthma: airways, pathophysiology  Self-monitoring to assess control and recognize signs of worsening asthma  Role of Medications: understanding the difference between  Quick-relief medications  Long-term control medications  Taking medications correctly  Avoiding environmental factors that worsen asthma  Develop a written asthma action plan

EPR3 Key Educational Messages

 Use the minute between two puffs!  When do school nurses see students with asthma? 1. Before PE

• 2. When they are symptomatic
• 3. When they bring a refill
• 4. Every other reason for a health office visit!

Time is always the barrier…how can we make use of brief, teachable moments?

 We do this routinely, spontaneously, but seldom track the lessons or document short snippets as “education”  Will it make a difference? Pre and post tests measure knowledge and self-efficacy  Ever wonder if asthma is a convenient “get out of class” excuse? Capturing assessment data and teaching a mini-lesson make every encounter worthwhile!

Minutes add up, but we don’t always count them…

 Checklist: teaching

• utline for school nurse

 Chart: capture airflow data to share with PCP  Cards: student collects as incentive & reminders

Asthma in a Minute

Space for self-care

 Peak Flow/ Forced Expiratory Volume meters  Inhaler technique teaching device  Asthma in a Minute Checklist, Chart and Cards  Poster of lungs & airways  Model of airway  Poster of medications  Use what you have!

Tools

 Basic asthma facts  Self-Monitoring  Medications  Triggers  Asthma Action Plan

Teaching Checklist

 Pre & post tests: asthma knowledge questionnaire  Asthma Control Test: five questions, scale 1-5

 Getting as much done as you want?  Shortness of breath?  Symptoms at night?  Used quick relief inhaler?  How would you rate control?

Checklist: measurable outcomes

 1. Respiration 101, lungs and airways  2. Airways with asthma*

 Constriction  Inflammation  Mucous

Basic Asthma Facts

 3. Recognize symptoms, day & night  4. Measure airflow: exhale HARD & FAST *  5. PEF/FEV1 skill check: coach a classmate

Self-monitoring

 6. Quick relief inhalers: help in a hurry  7. Control medication: ICS every day to prevent  8. Other medications prescribed for you  9. MDI use: inspiratory device, inhale SOFT & SLOW*  10. Spacer or holding chamber: delivers med better  11. Nebulizer: delivers the med differently  12. DPI [dry powder inhaler]  13. Inhaler skill check: coach a classmate

Medications

 14. Allergens and irritants, at home and everywhere*  15. Exercise-induced bronchospasm [EIB], activities and sports

Triggers

 16. Calculate your personal best numbers*  17. AAP: use what they were given, or suggest a plan  18. Bonus topic, review or new!

Asthma Action Plan

Capture the data  electronic record  on paper Share with  Parents  PCP

Assessing Airflow: Chart it!

 Younger students enjoy choosing the ring  Take advantage of small group competitive spirit  18 cards covering the

• utline, includes one

“bonus” wild card  Tweak as you like! words, pictures…your style

Collect the Key Cards

 Index cards listing brief reminder of the topic  Gather on a key ring, stored with the student’s MDI at school  Student will eventually take home as a visual reminder  Nurse and student can quickly see where they are on the education plan, as a checklist or posted on wall  If needed, additional time can be allocated with teacher collaboration

Keys to Asthma Control

 What’s the difference between PEF and FEV1?  FEV1 is considered the objective “Vital Sign” of asthma status  Peak Expiratory Flow measures HOW FAST the air is moving  Forced Expiratory Volume in One Second measures HOW MUCH air is exhaled, in liters

Peak flow/FEV monitors

Practice makes Perfect

Teaming Up for Asthma Control [TUAC]

 Start small, with a subset of students who routinely use MDIs at school  Adapt to any age level, but “spiral” the lesson to continually reinforce the key messages over time  Consider using students as peer leaders/teachers to present the concept to the younger class

Get started…and keep going!

 Missouri Asthma Prevention and Control Program  Teaming Up for Asthma Control [TUAC]  University of Missouri-Columbia  Asthma Ready Communities [ARC]  Asthma-Friendly Schools  Missouri Department of Health

[Missouri Asthma Prevention & Control Program, 2014]

Resources

 Centers for Disease Prevention and Control (2012). National asthma control program: Asthma fast stats. Retrieved from http://www.cdc.gov/asthma/NACP.htm  Missouri Asthma Prevention and Control Program (2014). Issue brief: Teaming up for asthma control, an outlook/analysis by urban and rural school zip codes. Retrieved from http://www.health.mo.gov/living/healthcondiseases/chronic/asthma/ pdf/TeamingUpforAsthmaControl.pdf  National Heart Lung and Blood Institute (2007). National asthma education and prevention program: Expert panel report 3, guidelines for the diagnosis and management of asthma, full report. U.S. Department of Health and Human Services. Retrieved from: https://www.nhlbi.nih.gov/files/docs/guidelines/asthgdln.pdf  National Heart Lung and Blood Institute (2011 update). Summary report, national asthma education and prevention program: Expert panel report 3, guidelines for the diagnosis and management of asthma. U.S. Department of Health and Human Services. Retrieved from: http://www.nhlbi.nih.gov/health-pro/guidelines/current/asthma- guidelines

References

Ahmad, E. & Grimes, D. E. (2011). The effects of self-management education for school-age children on asthma morbidity: A systematic review. The Journal of School Nursing, 27(4), 282-292. doi: 10.1177/1059840511403003 Coffman, J.M., Cabana, M.D., Yelin, E.H., Yelin (2009). Do school-based asthma education programs improve self-management and health outcomes? Pediatrics, 124(2), 729-742. doi: 10.1542/peds.2008-2085 Engelke, M. K., Swanson, M., & Guttu, M. (2013). Process and outcomes of school nurse case management for students with asthma. The Journal of School Nursing, 30(3). doi: 1059840513507084 Hester, L. L., Wilce, M. A., Gill, S. A., Disler, S. L., Collins, P., & Crawford, G. (2013). Roles

• f the state asthma program in implementing multicomponent, school‐based

asthma interventions. Journal of School Health, 83(12), 833-841. doi: 10.1111/josh.12101