California ED zeroes in on pediatric asthma

At Hemet Valley Medical Center’s ED in Hemet, CA, a task force targets pediatric asthma with a focus on education. The program began after one child had nine emergency department (ED) visits in one month and was at risk of dying.

"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."

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."

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. 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.

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 IQ test, inserted in this issue.)

All children ages 5 to 18 are trained in peak flows before they leave the ED. Patients are educated about controlling environmental triggers, through smoking cessation, removing or cleaning carpet, and covering mattresses and pillows with plastic, she notes. (See box on environmental preventions for asthma, p. 45.)

A pediatric asthma chart for children under 18 includes nursing diagnosis, response to interventions after 20 minutes, one hour, and three hours, and referrals. "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. (See Asthma Management, March 1999, p. 31, for more on the Huff and Puff program.)

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," she 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, pp. 46-47.)

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