Clinical Path Network: Asthma pathway treats and teaches patients

Program returns patients to normal living

An asthma pathway was implemented at Children’s Hospitals and Clinics in Minneapolis because this chronic disease is the No. 1 hospital admission.

The pathway creates a plan for the course of the patient’s hospitalization that helps to get the asthma under control, educates the patient and family members, and gets the patient back to a normal lifestyle quickly.

The average length of hospital stay is 2.4 days, and during this time patients undergo intense education.

The teaching is a collaborative effort between nursing staff, respiratory therapists, and pharmacists, says Diane Alexander, RPh, a clinical leader with the department of pharmacy.

The nurses get the patients and their families started by distributing a packet of educational materials. Nurses discuss things that may trigger the patient’s asthma and what to avoid.

The respiratory therapist teaches about peak flow meters and how to use them to monitor lung capacity and administer medications accordingly. He or she also teaches about the use of a nebulizer and the metered-dose inhalers.

Pharmacy teaches a class Monday through Friday that families are to attend before the child is discharged. Children are encouraged to attend the class if they are old enough to understand the information.

"We usually figure that if they are using a metered-dose inhaler, they can understand their treatment. If they are 7 or older, we would like them to come with their parent to the class," says Alexander.

The pharmacist knows what medications the patient is going home on, tailors the teaching to these specific medications, and answers any questions the family has. The pharmacists try to limit the class size to two patients, because any more than that makes the classes too long with so much of the information individualized.

It usually isn’t difficult to keep the class size down because the hospital admits about two asthma patients a day.

If a family can’t make the class, a pharmacist tries to do the teaching session in the patient’s room, but that request is harder to accommodate, Alexander says.

Class curriculum covers inflammation, triggers and what to avoid, how the different prescribed medications are used to control asthma and their importance, and compliance.

A flip chart is used to guide the educational session to ensure that all pharmacists cover the same information with all families. About seven pharmacists teach on a routine basis. During the class, patients receive a red/yellow/green zone sheet that the pharmacist fills out so patients know which medications to take when their peak-flow meter readings indicate that they are in a yellow or red zone. The respiratory therapist has filled in the peak flow meter numbers at the top of the sheet.

"They know by their peak flow numbers if they are going into that zone and they start adding therapies if they need to depending on what their red, green, and yellow zone tell them to do," Alexander says.

The main goal of the pathway is to reduce the number of readmissions, and the health care system has accomplished this. With the education program, patients and their parents recognize the signs and symptoms of an asthma problem early and know what they should be doing next, she says.