Barriers in Asthma Management: Partnering With Our School Nurse Becky Coviello, MSN, RN, CPN Director Pediatrics/Pediatric ICU/Neonatal ICU CJW Medical Center, Richmond Market Jennifer Soforenko MS, RN, CPN Pediatric/PICU Clinical Professional Development Specialty Educator Capital Division, Richmond Market HCA Healthcare CONFIDENTIAL – Contains proprietary information. CONFIDENTIAL – Contains proprietary information. Not intended for external distribution. Not intended for external distribution.
Pediatric Asthma Mission CJW Medical Center is committed to helping our pediatric asthma patients breathe a little easier by empowering our patients and families through consistent, age specific, and evidenced based asthma education. CONFIDENTIAL – Contains proprietary information. 2 Certification Journey: The school nurse’s role Not intended for external distribution.
Program Goals • To be recognized as a center of excellence in pediatric asthma care. • To standardize practices and education surrounding asthma care. CONFIDENTIAL – Contains proprietary information. 3 Certification Journey: The school nurse’s role Not intended for external distribution.
Team Members • Becky Coviello – Director and Team • Andrea Baumgardner – PICU Clinical Leader Coordinator • Courtnie Burrell – Facilitator • Rebecca Cox- PICU Staff Nurse • Dr. Asi-Bautista – Physician Lead • Dawn Kain- Pediatric ED Clinical and Intensivist Coordinator • Dr. Lewis-Prince – Pediatric • Britnie Jarrett- CH ED Educator Hospitalist • Alysa Timmerman –Pediatric • Dr. Frimpong- Medical Director for Respiratory Therapist Pediatric ED • Michelle Krieg- Pediatric Respiratory • Jennifer Soforenko – Specialty Therapist Educator • Kelly Maione – Respiratory Therapist • Gynette Schnieder – Pediatric Navigator Clinical Coordinator • Tara Cashion – Pediatric Staff Nurse CONFIDENTIAL – Contains proprietary information. 4 Certification Journey: The school nurse’s role Not intended for external distribution.
Asthma Admissions and ED Visits 2015 2016 2017 2018 2019 In-Patient 205 186 150 155 174 Volume In-Patient LOS 1.9 2.27 2.37 2.4 2.1 2015 2016 2017 2018 2019 All pediatric ED patients 24456 26968 26995 21940 20847 discharged to home All pediatric ED 767 739 636 asthma patients discharged home CONFIDENTIAL – Contains proprietary information. 5 Certification Journey: The school nurse’s role Not intended for external distribution.
Program Demographics- 2019 Gender Male Female 113 61 Ethnicity AA White Asian Other 116 37 1 20 Age 2 - 5 6 - 10 11 - 17 75 68 31 CONFIDENTIAL – Contains proprietary information. 6 Certification Journey: The school nurse’s role Not intended for external distribution.
Program Demographics- 2019 Admissions by District • Total asthma patients- 174 • Readmissions- 36 • Chesterfield- 74 • Readmission within 30 days- 1 • Richmond- 49 • Petersburg- 20 • Colonial Heights- 3 • Prince George- 5 • Hopewell- 9 • Henrico- 4 • Dinwiddie- 3 • Powhatan- 2 • Other- 5 CONFIDENTIAL – Contains proprietary information. 7 Certification Journey: The school nurse’s role Not intended for external distribution.
Child Lifetime and Current Prevalence in Virginia and the United States • In Virginia, 8.6% of adults (BRFSS, 2016) and 6.9% of children aged 0-17 years currently have asthma (NSCH, 2016). • This is slightly more than the U.S median of 7.9% (BRFSS, 2016) and 8.4% of children 0-17 (NSCH, 2016). CONFIDENTIAL – Contains proprietary information. 8 Certification Journey: The school nurse’s role Not intended for external distribution.
Asthma Diagnosis by School District CONFIDENTIAL – Contains proprietary information. 9 Certification Journey: The school nurse’s role Not intended for external distribution.
Performance Indicators • RT Navigator consult will be ordered for the asthmatic patient who meets one of the following criteria: o Readmitted within 30 days o Control Test ≤ 19 o A new asthmatic o Asthmatic that is started or restarted on a controller o Disease process deficit • Promote active self-assessment and self-management of asthma by having the patient 12- 17 years old (without documented developmental delays) or the caretaker (patients 2- 11 years) teach-back results of control test, early warning signs of asthma, and identify precipitating factors that aggravate their asthma (triggers) to healthcare worker. • All caregivers for 2- 11 years old asthmatic patients who are on a controller and patients 12-17 years old (without documented developmental delay) will teach back the difference between their controller and rescue medications after watching “What Is Asthma” from Iggy and the Inhalers. • Patients will be discharged home on appropriate asthma prescriptions that can be readily filled at their community pharmacy. CONFIDENTIAL – Contains proprietary information. 10 Certification Journey: The school nurse’s role Not intended for external distribution.
Performance Indicators Iggy and the Inhalers is our evidenced based education tool. • https://iggyandtheinhalers.com/ provides education videos, printable documents, and so much more. • Students and Parents can pull videos up on their phones to watch or use the laptop. CONFIDENTIAL – Contains proprietary information. 11 Certification Journey: The school nurse’s role Not intended for external distribution.
Performance Indicators for 2020- 2021 • Retire: o RT Navigator consult will be ordered for the asthmatic patient who meets one of the following criteria: Readmitted within 30 days Control Test ≤ 19 A new asthmatic Asthmatic that is started or restarted on a controller Disease process deficit • New: o Increased communication to our community- closing the loop between school and healthcare inpatient healthcare providers CONFIDENTIAL – Contains proprietary information. 12 Certification Journey: The school nurse’s role Not intended for external distribution.
Program Statistics Compliance Through April 2018 100% 100% 100% 100% 100% 100% 100% 92% 90% 90% 90% 89% 89% 87% 80% 80% 80% 77% 77% 75% 75% 73% 70% 70% 67% 66% 65% 60% 60% 60% 58% 56% 55% 55% 50% 50% 50% 50% 46% 46% 40% 40% 31% 30% 20% 20% 10% 0% 0% 0% 0% Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 Consult 0% 100% 67% 50% 40% 50% 66% 60% 75% 100% Documentation X3 0% 55% 46% 46% 65% 75% 100% 80% 56% 73% Proper Inhaler Use 0% 55% 58% 31% 60% 100% 100% 90% 89% 87% Video 20% 77% 50% 77% 70% 92% 100% 90% 89% 80% CONFIDENTIAL – Contains proprietary information. 13 Certification Journey: The school nurse’s role Not intended for external distribution.
Program Statistics Compliance: May 2018- Current 100% 100% 100% 100% 100% 100% 100% 100% 96% 90% 90% 88% 87% 87% 87% 86% 85% 81% 81% 80% 79% 79% 75% 75% 73% 70% 66% 65% 63% 60% 60% 60% 58% 52% 50% 50% 50% 50% 45% 42% 40% 30% 20% 11% 10% 5% 0% May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Consult 60% 42% 50% 100% 73% 81% 100% 88% 100% Teach Back: CT/EWS/Triggers 45% 52% 50% 100% 75% 65% 87% 63% 79% Teach Back: Control VS Rescue 60% 58% 50% 100% 96% 90% 87% 75% 86% DC Medication Availability 5% 11% 100% 100% 66% 85% 87% 81% 79% CONFIDENTIAL – Contains proprietary information. 14 Certification Journey: The school nurse’s role Not intended for external distribution.
Community Outreach Goals • Identification of patient population • Ensure a closed communication loop • Provide appropriate care • Provide education as a part of continuity of care CONFIDENTIAL – Contains proprietary information. 15 Certification Journey: The school nurse’s role Not intended for external distribution.
CONFIDENTIAL – Contains proprietary information. 16 Certification Journey: The school nurse’s role Not intended for external distribution.
CONFIDENTIAL – Contains proprietary information. 17 Title Name or Department Name Not intended for external distribution.
References 1. National Heart, Lung, and Blood Institute. (2007). Guidelines for the diagnosis and management of asthma (epr-3). Retrieved from https://www.nhlbi.nih.gov/health-topics/guidelines-for-diagnosis- management-of-asthma. 2. Iggy and the Inhalers. Retrieved from www.iggyandtheinahlers.com 3. BRFSS - Virginia Department of Health (2014). Virginia Behavioral Risk Factor Surveillance System. Retrieved from http://www.vdh.virginia.gov/livewell/data/surveys/brfss/ 4. NSCH 2011-2012 – National Survey of Children's Health. Data query from the Child and Adolescent Health Measurement Initiative, Data Resource • NIH National Heart, Lung and Blood Institute (2012). “What is Asthma?”. Retrieved from www.nhlbi.nih.gov/health/health-topics/topics/asthma/ CONFIDENTIAL – Contains proprietary information. 18 Title Name or Department Name Not intended for external distribution.
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