Barriers in Asthma Management: Partnering With Our School Nurse - - PowerPoint PPT Presentation

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Barriers in Asthma Management: Partnering With Our School Nurse - - PowerPoint PPT Presentation

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


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CONFIDENTIAL – Contains proprietary information. Not intended for external distribution. CONFIDENTIAL – Contains proprietary information. Not intended for external distribution.

Barriers in Asthma Management: Partnering With Our School Nurse

Jennifer Soforenko MS, RN, CPN Pediatric/PICU Clinical Professional Development Specialty Educator Capital Division, Richmond Market HCA Healthcare Becky Coviello, MSN, RN, CPN Director Pediatrics/Pediatric ICU/Neonatal ICU CJW Medical Center, Richmond Market

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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. Pediatric Asthma Mission

Certification Journey: The school nurse’s role

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  • To be recognized as a center of excellence in pediatric

asthma care.

  • To standardize practices and education surrounding

asthma care.

Program Goals

Certification Journey: The school nurse’s role

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Team Members

Certification Journey: The school nurse’s role

  • Becky Coviello – Director and Team

Leader

  • Courtnie Burrell – Facilitator
  • Dr. Asi-Bautista – Physician Lead

and Intensivist

  • Dr. Lewis-Prince – Pediatric

Hospitalist

  • Dr. Frimpong- Medical Director for

Pediatric ED

  • Jennifer Soforenko – Specialty

Educator

  • Gynette Schnieder – Pediatric

Clinical Coordinator

  • Tara Cashion – Pediatric Staff Nurse
  • Andrea Baumgardner – PICU Clinical

Coordinator

  • Rebecca Cox- PICU Staff Nurse
  • Dawn Kain- Pediatric ED Clinical

Coordinator

  • Britnie Jarrett- CH ED Educator
  • Alysa Timmerman –Pediatric

Respiratory Therapist

  • Michelle Krieg- Pediatric Respiratory

Therapist

  • Kelly Maione – Respiratory Therapist

Navigator

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Asthma Admissions and ED Visits

Certification Journey: The school nurse’s role

2015 2016 2017 2018 2019 In-Patient Volume 205 186 150 155 174 In-Patient LOS 1.9 2.27 2.37 2.4 2.1 2015 2016 2017 2018 2019

All pediatric ED patients discharged to home

24456 26968 26995 21940 20847

All pediatric ED asthma patients discharged home

767 739 636

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Program Demographics- 2019

Certification Journey: The school nurse’s role

Gender Male Female 113 61 Ethnicity AA White Asian Other 116 37 1 20 Age 2 - 5 6 - 10 11 - 17 75 68 31

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  • Total asthma patients- 174
  • Readmissions- 36
  • Readmission within 30 days- 1

Program Demographics- 2019

Admissions by District

  • Chesterfield- 74
  • Richmond- 49
  • Petersburg- 20
  • Colonial Heights- 3
  • Prince George- 5
  • Hopewell- 9
  • Henrico- 4
  • Dinwiddie- 3
  • Powhatan- 2
  • Other- 5

Certification Journey: The school nurse’s role

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  • 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).

Child Lifetime and Current Prevalence in Virginia and the United States

Certification Journey: The school nurse’s role

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Asthma Diagnosis by School District

Certification Journey: The school nurse’s role

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  • RT Navigator consult will be ordered for the asthmatic patient who meets one
  • f 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
  • 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.

Performance Indicators

Certification Journey: The school nurse’s role

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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.

Performance Indicators

Certification Journey: The school nurse’s role

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  • Retire:
  • 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:
  • Increased communication to our community- closing the loop between

school and healthcare inpatient healthcare providers

Performance Indicators for 2020- 2021

Certification Journey: The school nurse’s role

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Program Statistics

Certification Journey: The school nurse’s role

0% 100% 67% 50% 40% 50% 66% 60% 75% 100% 0% 55% 46% 46% 65% 75% 100% 80% 56% 73% 0% 55% 58% 31% 60% 100% 100% 90% 89% 87% 20% 77% 50% 77% 70% 92% 100% 90% 89% 80% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 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%

Compliance Through April 2018

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Program Statistics

Certification Journey: The school nurse’s role

60% 42% 50% 100% 73% 81% 100% 88% 100% 45% 52% 50% 100% 75% 65% 87% 63% 79% 60% 58% 50% 100% 96% 90% 87% 75% 86% 5% 11% 100% 100% 66% 85% 87% 81% 79% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 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%

Compliance: May 2018- Current

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  • Identification of patient population
  • Ensure a closed communication loop
  • Provide appropriate care
  • Provide education as a part of continuity of care

Community Outreach Goals

Certification Journey: The school nurse’s role

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16 Certification Journey: The school nurse’s role

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17 Title Name or Department Name

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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/

References

Title Name or Department Name