Emanuel Children’s Clinic

Summary of Progress:• Improved optimal asthma care to 72%• Increased the use of a written asthma

action plan to greater then 90% through the month of February. March data returned lower scores

• Assessing asthma control with a validated instrument and using stepwise approach 100% of the time.

EQIPP DATA GRAPHS

• Percentage of optimal asthma care. Error in entering flu vaccine data has suppressed this number.

• Asthma action plan. Last data cycle shows dip in asthma action plan use.

EQIPP DATA GRAPHS

• Stepwise approach

• Validated instrument

• Patients 6 mos and older with a recommendation for a Flu Vaccine

Nurse collects form

enters patient

information into EMR

physician fills out the remainder of

form

Off

ice

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Pre

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urin

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ffic

e V

isit

Pos

t V

isit

Act

iviti

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Nurse Supervisor Or Administrative office assistant

Collects encounter form andverifies for

completeness

Clinic data shared with

Physician team during monthly

meeting

All necessary information on

the form is entered into

EQIPP

Clinical Assessment Process Map – Emanuel Children’s Clinic

Rooming nurse/MD huddle at the start of each shift to identify

patients needing asthma encounter form

EQIPP Data reviewed by physician leader

And Nurse supervisor

Form completeAt time ofrooming

Form incompleteAt time of

Patient rooming

Physician collects Form enters data

Into EMRNurse schedules spirometry

Provides education and Handouts as ordered

From MD.Administer flu shot if ordered

RN gives encounter form to family

MD uses stepwise Approach.

Adjust medication As needed

Asthma action plan Filled out

Referral to spirometry As needed.

Flu vaccine discussedAsthma Education

Provided

Completed form placed into collection folder for later data entry

Concern:Data incorrectly Entered for FLU

When advised but not Given

Plan: Admin AssistantWill correctly enter

Data into EQIPP

Concern: Asthma action plan not always initiated or

UpdatedPlan: RN staff will now place

Blank asthma action plans on All charts ID with asthma

PDSA

Concern:Limited time for MD to provide

education Plan: RN’s Will educate

families and give handouts.

PDSA

Nurse gives front Desk staff the

encounter form To be handed out

To parents at check in

Concern: Same day appointments

Not ID with asthma During morning huddle

PDSA

Nurse usesMedication List to ID Asthma

Pt.

Changes Identified during physician meeting are tested

using PDSA and implemented during next collection period

Complete

Incomplete

Office Flow Diagram

PDSA Ramp

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Identification of asthma patients

TEST 1What: ID Asthma PatientsWho: Dr. Greenlee +RN Where: Dr. Greenlee’s Office When: Morning MeetingWho executes: RN gives form to front officeResults: Increased use of asthma form.

TEST 2What: ID Asthma PatientsWho: All MD’s + RN Where: MD officesWhen: Morning MeetingWho executes: RN gives form to front desk for delivery to patients. Results:Increased use of asthma Form. Same day patients not ID during morning meeting

TEST 3What: ID asthma patients SDA Who: RNWhere: exam room When: During rooming processWho executes: RN ID’s patients using medication list:--If on asthma medication form given.Results: Increased use of asthma form for same day patients. If no asthma medication listed still missed using form.

TEST 4What: ID asthma patientsWho: MDWhere: exam room When: during visit Who executes: MD ID patients in the room missed during morning meeting and rooming process. MD fills out asthma form with familyResults: Increased the use of asthma form not previously ID

PDSA Ramp

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Increase the use of the Asthma action plan

TEST 1What: Patients ID during morning huddle will have an updated asthma action plan upon leaving clinicWho: Dr. Greenlee +RN Where: Dr. Greenlee’s Office When: Morning MeetingWho executes: MD updates or creates new action planResults: All patients ID with asthma had new or updated form

TEST 2What: Patients ID during morning huddle will have an updated asthma action plan upon leaving clinicWho: All MD’s + RN Where: MD officesWhen: Morning MeetingWho executes: MD updates or creates new action plan Results: Sporadic use or asthma action plan. MD’s not always updating or creating new plan.

TEST 3What: Patients ID during morning huddle will have an updated asthma action plan upon leaving clinicWho: RNWhere: Pt Check in When: upon patient arrival Who executes: RN will place a new action plan on every chart of a patient ID with asthma Results: Increased use of asthma action plan..

TEST 4What: Patients ID during rooming process will have an updated asthma action plan upon leaving clinicWho: RNWhere: exam room When: during rooming process Who executes: RN: patients missed during morning meeting but ID during rooming process with asthma. Will have asthma action form placed on front of chart for MD to fill out.Results: Increased the use of asthma action plan on patients not previously ID

Key LearningQuality improvement starts with small changes.

Learned about PDSA cycles

Registry is necessary for optimal asthma management.

Takes the entire team’s buy-in to successfully make improvements.

Due to compliance would be most beneficial to complete spirometry during clinic visit.

Future Plans•Spirometry in clinic

•Grant written to obtain spirometry. Grant was successful. Clinic will obtain new machine and training this spring. This will allow us to complete spirometry at the time of appointment. Increase family compliance.

•Registry

•Clinic developing new EMR “EPIC” with some registry functions?

•Currently working on excel spreadsheet.

•Education

•Nurses will be main asthma educator for family and patients. Developing new handouts. Providing educational in-service for RN staff with MD.