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