Emergency department targets pediatric asthma

At Hemet Valley Medical Center’s ED in Hemet, CA, a task force that targets pediatric asthma with a focus on education began after one child had nine ED visits in one month and was at risk for death.

"She came in cyanotic with acute conditions many times," says Jessica Lopez, RCP, CRTT, RTT, respiratory therapy educator for the ED.

The child wasn’t able to get her inhalers refilled because she would use all of her doses in two weeks, Lopez recalls.

"She had many middle of the night trips to the ED, and her family had no car or phone, which increased our concern," she says. "It was clear she was going to be a frequent flier constantly if we didn’t correct this."

A task force was formed to address the problem, including monthly tracking of pediatric asthma patients. A tracking form is used to review charts of all asthma patients ages 0 to 18, then the data is compiled into quarterly data. (See QA/I Retrieval Form for Pediatric Asthma Patients, inserted in this issue.) A Variance Tracking Sheet is used to track problems of managing asthma patients in a timely manner and documents delays in available beds, information, and supplies or ancillary services. (See form inserted in this issue.)

An educational packet was created, and is handed out to every asthma patient. "It’s written at the third-grade reading level and includes things to do at home to keep asthma from flaring up, such as reminders to do peak flow monitoring," says Lopez.

The packet includes a coloring book, asthma calendar, and asthma IQ quiz. (See Asthma Explorers calendar and "Check your asthma IQ" form, inserted in this issue.)

All children aged 5 to 18 are trained in peak flows before they leave the ED. Patients are educated about environmental triggers, such as smoking cessation, removing or cleaning carpet, and covering mattresses and pillows with plastic, notes Lopez. (See chart on environmental preventions for asthma, p. 72.)

A pediatric asthma chart for children less than 18 includes nursing diagnosis, response to interventions after 20 minutes, one hour, and three hours, and referrals. (See form, inserted in this issue.)

"The form includes making sure all children patient receives asthma education before they leave the ED, and get a referral to our Huff and Puff classes, which are held each month at one of three hospitals," says Lopez.

Outreach education is done at schools with local pediatricians. "Our ED asthma committee is currently meeting with our two school districts to provide further education for teachers and students," Lopez reports.

A form is given to schools for asthmatic children, including emergency contact information, daily asthma management plan, daily medication plan, and steps to take during asthma episodes. (See Asthma Student Action Information form, p. 70.)

Huff and Puff program a success

A three-session Huff and Puff asthma program is available for children ages 2 through 13. Only parents attend the first session, which includes how asthma affects the lungs, how to monitor a child’s signals, asthma triggers, medications, prevention of signals, and asthma control plan. Both parents and children attend the following two sessions.

"We focus a lot on emergency patients who we see frequently. If a child has no transportation, someone will pick them up and bring them to class," says Lopez.

Insurance companies provided incentives for ED patients if they complete the hospital’s asthma programs, such as gift certificates to local supermarkets.

Asthmatic children who visit the ED frequently are at risk of death, stresses Lopez.

"A lot of times they don’t follow through with their primary care provider, so they are at great risk," she says. "Asthma visits have been increasing every year, especially among young children. Our goal is to keep them from having a debilitating illness or permanent brain injury from their asthma." (See p. 75 for more on avoiding asthma fatalities.)


For more information on the Huff and Puff pediatric asthma program, contact:

Jessica Lopez, RCP, CRTT, RTT, Hemet Valley Medical Center, 1117 E. Devonshire Ave., Hemet, CA 92543. Telephone: (909) 652-2811 ext. 5941.