Transcript American Lung Association 27th Annual Respiratory care

American Lung
Association
th
27 Annual Respiratory
Care Conference
Asthma Response Team
Clifton Dennis, RRT, AE-C
Pediatric Lifetime and Current
Prevalence
18
16
14
12
10
Lifetime
current
8
6
4
2
0
Georgia
38 States
Pediatric Asthma Prevalence
16
14
12
10
Georgia
38 States
8
6
4
2
0
0-4 years
5-9 years
10-14 years
15-17 years
Pediatric Asthma By Sex
16
14
12
10
Georgia
38 States
8
6
4
2
0
Boys
Girls
Pediatric Asthma By
Race/Ethnicity
20
18
16
14
12
Georgia
38 States
10
8
6
4
2
0
White
Blacks
Hispanic
Other
Multirace
Pediatric Asthma Hospitalization
Rates
Georgia
250
200
150
100
50
0
0-4 yrs
5-9 yrs
10-14 yrs
14-17 yrs
Asthma Deaths
30
25
20
Georgia
United States
15
10
5
0
White
Black
Other
Pediatric Asthma Deaths
CSRA 1999-2006
4.5
4
3.5
3
2.5
2
1.5
1
0.5
0
1999
2000
2001
2002
2003
2004
2005
2006
Asthma Response Team responsibilities
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Introduction and explanation of why we are here
Complete ART encounter form
Initial PEF, FVC. FEV1
Will determine severity based on EPR-3 guidelines for this admission
Review two week history of symptoms to determine severity
Review one year history to determine risk
Review asthma disease and the asthma process provide asthma booklet/packet
Explain the use of Quick Relievers and Controllers
1. Review albuterol use
2. Review ICS usage
3. Review MDI/DPI usage with demonstration
Review triggers- Mention smoking cessation
1. Trigger avoidance
2. Ozone trigger
3. Encasements- available through CMS if qualified
Review spacer with/without mask
1. Provide adults with spacer
2. Provide children with spacer /mask in Asthma Kit
Review peak flow meter usage
1. Teach proper peak flow
2. Label peak flow meter with predicted values
Insure follow up appointment is made prior to discharge
1. Specialist appointment is recommended for high risk, moderate to severe patients
2. Intermittent to mild may follow up with PCP May use MCG continuity Clinic@ 721 -2143 from 8-4:30 as walk in if needed
Complete Asthma Action Plan- Utilize GREAT for asthma action plan. Will require parental signature
1. 1- copy to parent/patient
2. 1- copy for medical records (signed copy)
3. 1- copy for ART team
4. This will be faxed to school nurse and PCP if applicable
Provide Asthma kit, spacers & peak flow meters
Document whom provided ART services, equipment used and serviced provided by the ART team member.
Asthma Response Team Encounter Form
Patient Information
Race
Gender
Patient name
Date of birth
Age
Height
Clinical
asthma
severity score
(CAS)
Score
Triage score
30 minute
score
1 hour score
Discharge
Score
Inpatient admit
score
PICU admit
score
Predicted Peak flow
Actual PEF
FEV1
FVC
Impairment
Coughing
Wheezing
Trouble breathing
Limited activities
Awaking at night
Patient label
Visit Information
Visit date
Primary care MD
School
County
Zip code
Emergency room physician
Reason for visit
Severity of Asthma
Well controlled
Not well controlled
Very poorly controlled
# of days in past two weeks
Past Asthma History ( Risk)
# of visits to ER for asthma in past 12 mos.
# of office visits for asthma last 12 mos.
# of hospital admissions for asthma
(2/yr persistent)
# of ICU admissions for asthma (1=persistent)
# of times oral steroids have been used in 12 mos. (
more than 2 /yr = persistent asthma)
Use of quick relievers
Current Medications
Albuterol
( Proair, Ventolin,Proventil)
Levalbuterol ( Xopenex)
Cromolyn, Intal, Tilade
Inhaled Steroid
( Flovent, Pulmicort, Qvar,Areobid,Asmenex)
Oral steroid
( Prednisone, Deltasone, Prednisolone,
Decadron, Prelone, Pedipred)
Leukotriene modifiers
( Singulair,Accolate,Zyflo )
PO
Services Provide by ART Team
member
Supplies provided to patient
Nebulizer Treatment
Peak flow meter
MDI treatment
Spacer with mask
DPI treatment
Spacer without mask
Education
Asthma Kit
Home Phone #_________________________________________________________________________________
Cell Phone# ___________________________________________________________________________________
Alternate # ____________________________________________________________________________________
Jet
MDI
DPI
Classification
Intermittent
Mild persistent
Moderate
Severe Persistent
Residence Counties
200
180
160
140
120
100
80
60
40
20
0
Richmond county
Aiken County
Columbia County Edgefield County
Children's Medical Service
Enrollment
120
103
100
86
80
60
55
40
20
0
CMS
Asthma PACK
Asthma Classification
120
100
80
60
40
20
0
intermittent
mild persistent
moderate
persistent
severe persistent
Health Care Utilization
3
2.5
2.5
2
2
1.5
1
1
0.5
0
0
Avg. ED visits
Avg. PCP visits
Avg.
Hospitalizations
Avg. PICU
admissions
Average CAS by location
7
6
6
5
4
3
5
4
3
3
2
1
1
0
initial score 30 min score 1 hour score Discharge
score
Inpatient
score
PICU score
Patient Disposition
250
217
200
PICU
Inpatient
ED Discharge
7 day return
150
100
50
24
3
0
5
Metrics
Teamwork Award for ART team
References
• Introduction: Enhancing the role of the
emergency Department in the identification and
management of childhood asthma: Rechelefsky,
Kennedy, and Stone Pediatrics 2006
• Expert Panel Review number 3, NHLBI, 2007
• Behavioral Risk Factor Surveillance System,
(BRFSS) CDC ,2008