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ASTHMA PROGRAM UPDATEFall 2012
South Shore HospitalJesslyn Murphy, MHA, RRT-NPS, C-NPT, AE-C
Federal Action Plan to Reduce Federal Action Plan to Reduce Asthma DisparitiesAsthma Disparities
Strategy 1: Reduce barriers to the implementation of guidelines based asthma management.
Strategy 2: Enhance Capacity to deliver integrated, comprehensive asthma care to children in communities with racial and ethnic asthma disparities
Strategy 3: Improve capacity to identify the children most impacted by asthma disparities.
Strategy 4: Accelerate efforts to identify & test interventions that my prevent the onset of asthma among ethnic & racial minority children.
Community OutreachCommunity Outreach• School RN education and CEUs
– 7 Presentations, 170 School RNs– 5,131 Asthmatics (34,349 Students)
• Daycare provider education• Health Fares• Professional Education• Youth Health Connection• Physician group
presentations
Community InvolvementCommunity Involvement
• Asthma Regional Council (ARC)• Massachusetts Asthma Action Partnership
(MAAP)• Research• CHNA 22 Panelist• Community Benefit Payments
Community SupportCommunity Support
• Spirometry Grant• Harold Brooks Foundation Grant
Michelle Solari, RNVNA
Michelle Solari, RNVNA
Carol Altonen, NNPVNA
Carol Altonen, NNPVNA
RNsVNA PCH Division
RNsVNA PCH Division
Jesslyn Murphy, RRTProject Manager
Jesslyn Murphy, RRTProject Manager
Tammy Ryan, RNDirector, VNA
Tammy Ryan, RNDirector, VNA
Mark Waltzman, MDMedical Director
Mark Waltzman, MDMedical Director
Greg Cardello, MDPediatric Hospitalist
Greg Cardello, MDPediatric Hospitalist
Jeremy Warhaftig, MDSSMC MD
Jeremy Warhaftig, MDSSMC MD
Beth Klements, PNPCHB Asthma CNS
Beth Klements, PNPCHB Asthma CNS
Geraldine McNamaraMedical Perf. Mgmt. DirectorGeraldine McNamaraMedical Perf. Mgmt. Director
Kim NobleVNA, YHC
Kim NobleVNA, YHC
TBDPatient / Family Advisor
TBDPatient / Family Advisor
Linda BarrosMgr. Healthy Homes Program
CHNA 22 Represenative
Linda BarrosMgr. Healthy Homes Program
CHNA 22 Represenative
Cindy Cookson, RRTNHP
Cindy Cookson, RRTNHP
Charlie ArientiDirector, Resp. Care &
Clinical Engineering
Charlie ArientiDirector, Resp. Care &
Clinical Engineering
Kathleen PetersenRN Manager, VNA
Kathleen PetersenRN Manager, VNA
Harold Brooks Foundation Harold Brooks Foundation Pediatric Asthma GrantPediatric Asthma Grant
ORGANIZATIONAL CHARTORGANIZATIONAL CHART
ProgressProgress• In-Patient Albuterol Protocols• Comprehensive education • Asthma Action Plans• Asthma Classification Tests• Community Outreach• BAA with Self Help, Inc.• ER Triage RN Driven Albuterol
Home Bases Environmental Home Bases Environmental Interventions: Spectrum of IntensityInterventions: Spectrum of Intensity
Examples of Interventions
Source: CDC Task Force on Community Preventative Services. “Asthma Control: Home-Based Multi-Trigger, Multicomponent Environmental Interventions Summary Evidence Tables – Economic review:
Science Science Evidenced Based Practices Evidenced Based Practices
• Use Inhaled corticosteroids• Use written Asthma Action Plans• Assess asthma severity• Assess and monitor asthma
control• Schedule follow-up visits• Control environmental exposures
HASS Based OrdersetHASS Based OrdersetSEVERE ASTHMA MANAGEMENT: HASS SCORE = 10-15
Consult to Inpatient Pediatric Hospitalists Consult to Pedi/NICU RT via page 3 stacked Albuterol/Ipatroprium nebs Corticosteroids
CONSIDER: Continuous Aerosolized BronchodilatorOxygen as indicated HelioxEtCO2 MagnesiumTerbutalineScore q 30 minutes
MODERATE ASTHMA MANAGEMENT: HASS SCORE = 7-9
Consult to Pedi/NICU RT via pageCONSIDER
3 stacked Albuterol/Ipatroprium nebsSystemic corticosteroids Oxygen as indicatedScore q 1 hour
MILD ASTHMA MANAGEMENT: HASS SCORE = 5-7CONSIDER
Nebulizer therapyOxygen as indicated Score q 1-2 hours
ReadmissionsReadmissions
Monitored ParametersMonitored Parameters• Admitting Diagnosis• ED Priority• LOS• ED & Adm. HASS• SABA Times
• Order• Override• Delivery
• Steroid Time• Door to Admit• Admit to Floor
• Transfers• Decompensation• Education• Asthma Action Plan• Town • Insurance • PCP & Practice
FY2012 MetricsFY2012 MetricsFY2012
Visits 241 Re-visits 6.22% Transfers 12% Admitted 70% ER Only 33% Direct Admit 1%Goal / Metrics: Door 2 MD <30 mins 60% SABA <30 mins 38% Steroids <120 mins 65%Flow:
Door to admission (min) mean 196
Admission to Floor (min) mean 102
GoalsGoals
• Increase efficiency – E.g. Triage RN Initiated Albuterol Protocol
• Improve awareness– Internally & Externally
• Joint Commission disease specific accreditation for asthma
Net Annual Loss
$- 4,283,604
Information per SSH FY12 Finance Report provided by Dan Tenaglia
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