• Improving Provider Compliance in the Use of an Asthma Action Plan for Patients with Asthma in an Outpatient Setting

      Bundy, Elaine Y. (2011)
      Problem: Improved patient asthma outcomes, operationally defined as decreased acute care visits, reduced missed days from school and work, and decreased nocturnal awakenings due to asthma symptoms, have been demonstrated through the use of a symptom based written asthma action plan (AAP) in reducing acute care visits (Gibson & Powell, 2004; Zemek, Bhogal, & Ducharme, 2008). However, despite the research and guideline recommendations that support the use of AAPs, these plans are routinely not used by providers. In fact, only 25 percent to 56 percent of all asthma patients receive an AAP (Rank, Volcheck, Li, Patel, & Lim, 2008). Thus, the purpose of the Capstone project was to improve provider compliance in an outpatient office in the use of a symptom based AAP. Methods: The Capstone quality improvement (QI) project was conducted during a specific two month period (coinciding with the study period in the fall and winter of 2010) in a suburban outpatient allergy and asthma clinic in Glen Burnie, Maryland. The QI project involved an educational in-service on the use of an AAP and a system procedural change (placing a blank AAP on each patient’s medical record at the time of visit). A retrospective medical record review was conducted from all eligible medical records of patients greater than six years of age diagnosed with asthma that were seen in the office during the two month study period following the educational in-service in order to assess the use and completeness of the AAP (N = 42). The rate of proportional change (percentages) in compliance in the use of an AAP after the educational in-service and system procedural change was analyzed and reported. Results: A statistically significant improvement in provider compliance to the use and completion of a symptom based AAP was found at eight weeks following an educational in-service and system procedural change. A statistically significant change (p < .001) in provider IMPROVING PROVIDER ASTHMA ACTION PLAN COMPLIANCE 2 compliance was found as evidenced by a 79 percent (33/42) increase in the use and completion of a symptom based AAP following the intervention (education and system procedural change) as compared to less than 5 percent (2/42) rate of compliance prior to the intervention. Discussion: The role of the Doctor of Nursing Practice (DNP) is to synthesize the evidence and implement the best evidence and recommended national guidelines. The QI project paralleled the role of the DNP in the implementation of evidence based research and guidelines in conducting an educational in-service and system procedural change to improve provider compliance in the completion and use of a symptom based AAP within an organization. The project demonstrated the effectiveness of an educational in-service in improving provider compliance in the use of and the completion of a symptom based AAP.
    • 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.