• Utilization of Written Asthma Action Plan In a Pediatric Primary Care Setting

      Efunbajo, Grace; Hoffman, Ann G. (2020-05)
      Problem: Asthma is a common and potentially serious chronic disease that affects over 20 million adults and 6 million children in the United States. Pediatric standard of care supports providing an asthma action plan to asthma patients/families. The use of asthma action plans (AAP) has been associated with improved asthma patient outcomes. Studies have shown poor utilization of AAP by healthcare providers for promoting self-management and self-efficacy. Purpose: The purpose of this DNP quality improvement project was to implement and evaluate the use of personalized written asthma action plans by healthcare providers in a pediatric primary care setting. Methods: The project was implemented over a 13-week period beginning in September of 2019. Participants were existing and newly diagnosed asthma patients less than or equal to 21years old who were receiving care for sick visits or annual physical examination. The conceptual framework of the project was based on Kurt Lewin’s change theory. In addition, a 4-hour education and training on asthma and the importance of the AAP was given to the healthcare providers (a physician and nurse practitioner), the office manager, and supporting members of staff. Healthcare providers and medical assistants were equally trained on how to complete an asthma action plan. The change process included the use of a colored paper asthma action plan and medical assistants provided the AAP sheet with a completed demographic section of the tool before the medical provider completed the other sections. Results: During the implementation period, data were collected on the number of AAP’s completed by the healthcare providers. This information was aggregated through a chart audit of de-identified copies of completed AAP’s. Run charts were used for data analysis. The clinic achieved 90% of AAP utilization rate, which surpassed the 60% goal of the project. Conclusion: The implementation and utilization of a written asthma action plan and in-service training in a pediatric outpatient setting improves patient accessibility to a treatment plan by primary care healthcare providers. The use of an evidence-based AAP can enhance patient management of asthma by giving patients and caregivers a roadmap to asthma care.
    • Written Asthma Action Plan Implementation and Evaluation in Pediatric Primary Care

      Roberts, Courtney O.; Satyshur, Rosemarie D. (2021-05)
      Problem & Purpose: Asthma guidelines recommend the use of written asthma action plans (WAAPs) in the management of pediatric asthma patients, but this is not always practiced in the primary care setting (Global Initiative for Asthma [GINA], 2019; National Asthma Education and Prevention Program [NAEPP], 2007; Ring et al., 2015). Lack of proper asthma management can lead to an increase in asthma related unscheduled sick visits. The purpose of this quality improvement project is to implement and evaluate a WAAP for pediatric asthma patients in a pediatric primary care clinic in the Eastern Shore Maryland area. Methods: Implementation of a WAAP involved one pediatrician, two pediatric nurse practitioners, and the pediatric patients between the ages of 1 to18 years old being seen for asthma management. The project took place at a pediatric primary care clinic on the Eastern Shore Maryland beginning August 31, 2020 and concluding on December 11, 2020. Early on, staff were educated on the WAAP via email that included a recorded PowerPoint presentation as well as a post-test, instructional asthma videos, a WAAP template, and the Asthma Quick Reference Guidelines pdf. After implementation began, weekly chart audits assessed WAAP utilization. Data collected were organized using Excel sheets. Run charts were created and updated weekly to trend the data. Flyers were created and disseminated in the in the office to encourage staff and patient engagement. Weekly WAAP update emails were sent out to staff to update them on the progress of the project. No personal patient or provider information was collected for this quality improvement project. Humans Research Protections Office (HRPO) approval was gained through the University of Maryland. Results: All eight staff members completed the staff education before September 15. The WAAP utilization goal was met, and 100% of asthma patients being seen were given a WAAP by week fifteen. Unscheduled sick visits decreased to 0% by week fifteen. Conclusion: This quality improvement project demonstrated that WAAP utilization by providers for pediatric asthma patients can decrease unscheduled sick visits.