Southern Oregon Pediatrics

Optimal Asthma Care Project

Identify Asthma Patients at check – in

Parents to complete the Asthma Data Collection Form given by

the front desk staff

Office Manager goes into the EMR and

pulls up the completed Data

collection forms and enters the data into

EQIPP

Completed data form is toBe given to the RN

In exam roomBy patient.

Yes

Physician completes their section

Of questions on theAsthma Data Collection

Form directlyInto the EMR

No

Nurse to go over questions on the form and enter patients

answers into the EMR in exam room

Either the RN or the physician

enters the patients data

from form into the EMR

Follow up appointment immediately Scheduled within the next 2 weeks to

Get a formal asthma evaluation with spriometry.

Southern Oregon Pediatrics Acute Visit Flow Chart

1.

1.

Problem Points:

1.2.

Making sure patients follow thru with recheck appt.

2.

Making sure we have enough time to enter the answers from the CAQI form before Dr. enters exam room.

Spriometry performed by

MA/RN and data is put on fee

ticket for physician to

review.

Patient is ready to be seen

by Physician

During the visit the physician fills out the

form while havingInformed clinical

DiscussionQuestions 1-27

If patient is well

controlled a follow up visit will be made in 6 months. If patient is not in good control the

follow up will be

determined by physician

Parent/patient education

handouts given

And Action plan given and reviewed

YES

Duri

ng

O

ffice

Vis

itPo

st V

isit

A

ctiv

itie

s

Brenda pulls up Report with

All completed forms.Forms will not appear

Until visit isSigned by

Doctor.

If necessary, go to physician to obtain missing

information or to have them sign

the patient’s record if complete

NO

All necessary information on

the form is entered into EQIPP by

Brenda

Brenda verifies in schedule that parent hasScheduled the follow up

Appointment recommended byThe physician

Southern Oregon Pediatrics

Clinical Assessment Process Map

MA/RN rooms pt. And makes sure

CAQI form is completed for

physician review

CAQI form attached by the records staff when preparing tickets for next days appts on asthma patients identified in

the EMR Pre

Vis

it

TEST 1What: ensuring all asthma ptscomplete a CAQI formWho: Front DeskWhere: Waiting room or Exam RoomWhen: prior to Dr. in room

PD

S A

TEST 2What:: revised process for forms to bePlaced on pts with specific dx.Who: records clerkWhere: to be paper clipped behindFee ticket so front desk canHave completed at check inWhen: day before appt its attached

P D

S A

TEST 1What: need spirometry machineWho: Barb ordered and calibratedWhere: back officeWhen: decided in Dec 2009

P D

S A

TEST 2What: training of staff on spirometerWho : all MA’s and RN’sWho : Barb set up training mtgWhere: officeWhen: 2/16/10

P D

S A

TEST 3What: implementing routine testing On all asthma visitsWho: MA’s and RN’s have all beenTrained and have practiced onNew machineWhere: officeWhen: ongoing

P D

S A

TEST 4What: ongoing familiarity with gettingThe data printed out.Who: MA’s and RN’sWho :Barb is our main contactPerson for problems with the Machine. Where: She helps resolve any Equipment issuesWhen: ongoing

P D

S A

TEST 1What: physician directs pt to Schedule rck appt to obtain A complete asthma evaluationWho : patient familiesWho (executes): physicianWhere: during unrelated acute apptWhere need was identifiedWhen: at unrelated appt

P D

S A

TEST 2What: revised plan to have parentsBe escorted to a scheduler toMake a follow up asthma apptWho : patient familyWho : physician or nurseWhere: at schedulers deskWhen: after unrelated acute appt

P D

S A

TEST 3What: Action in case a pt cancels orno shows follow up rck asthma apptWho: patientWho : front desk/RN sends msg To physician that pt has not kept appt. Call placed to pt to rescheduleWhere: msg sent in EMRWhen: at time of cancellation or after the no showed appt

P D

S A

Encounter Forms Spriometry Follow up Appointments

Southern Oregon Pediatrics

PDSA WORKSHEET

PLAN: Briefly describe the test: To get 90% of our asthma patients to complete the Data Collection Form How will you know that the change is an improvement? By the number of forms completed in the HER on all patients with the diagnosis Reactive Airway Disease or wheezing What driver does the change impact? none What do you predict will happen? That it will give us results that will help us improve the process to better our percentage of patients being offered the form. PLAN

List the tasks necessary to complete this test (what)

Person responsible

(who) When Where 1. Trained Michelle on what patients get the form

Michelle E.

10/5/09

Medical records room

2. Trained entire front staff on form completion

Sherri

10/8/09

Employee lounge

3. Notified back office staff of form and what patients need to complete it

Barbara B

10/9/09

By email

4. Made copies of blank data collection forms for each nurse station

Michelle

10/9/09

N/A

5. 6.

Plan for collection of data: Have Dr Hough run a report on all asthma patients with the dx of RAD or wheeze and collect the number of those pts that completed a form.

DO: Test the changes. Was the cycle carried out as planned? x Yes No Record data and observations. Form got put on all the appropriate patients since the execution date. What did you observe that was not part of our plan? nothing

STUDY: Did the results match your predictions? x Yes No Compare the result of your test to your previous performance: What did you learn? That good and precise training is key for the execution of the task to be successful. ACT: Decide to Adopt, Adapt, or Abandon. X Adapt: Improve the change and continue testing plan.

Plans/changes for next test:

Adopt: Select changes to implement on a larger scale and develop an implementation plan and plan for sustainability

Abandon: Discard this change idea and try a different one

Team Name: Southern Oregon Pediatrics Date of test:10-9-09 Test Completion Date: 12/15/09

Overall team/project aim:

What is the objective of the test? To get the data collection forms to 90% of our patients

What 90 day goal does the change impact? none

Do

Study Act

Plan

PDSA WORKSHEET

PLAN: Briefly describe the test: To get complete and accurate data from our spirometry machine How will you know that the change is an improvement? Once our new equipment is installed and tested, then we can implement getting our asthma patients scheduled and have data to complete their asthma action plans. What driver does the change impact? Scheduling patients and making sure they are given enough time to complete the test at the time of the visit and to ensure reliable asthma care. What do you predict will happen? This will improve the management of their asthma care with these results PLAN

List the tasks necessary to complete this test (what)

Person responsible

(who) When Where 1. Purchase Spirometry machine

Barb Bruce

1/14/10

Office

2. Calibrate and test machine

Barb Bruce

1/30/10

Office

3. Training staff of scheduling requirements

Brenda- front staff Barb - nursing

1/14/10-2/1/10

Front staff and nursing meeting

4. Implement plan

Barb and Brenda

2/1/10

Office

5.

6.

Plan for collection of data:

DO: Test the changes. Was the cycle carried out as planned? x Yes No Record data and observations. Recognized that our old machine was not giving accurate results and breaking down forcing us to purchase a new machine What did you observe that was not part of our plan? nothing

STUDY: Did the results match your predictions? x Yes No Compare the result of your test to your previous performance: What did you learn? That good and precise training is key for the execution of the task to be successful. ACT: Decide to Adopt, Adapt, or Abandon. X Adapt: Improve the change and continue testing plan.

Plans/changes for next test:

Adopt: Select changes to implement on a larger scale and develop an implementation plan and plan for sustainability

Abandon: Discard this change idea and try a different one

Team Name: Southern Oregon Pediatrics Date of test:1/14/10 Test Completion Date:2/1/10

Overall team/project aim: spirometry completed on all asthmatic patients over 5 years of age.

What is the objective of the test? to get patients scheduled for spirometry if they haven’t had this in prior years.

What 90 day goal does the change impact? The future process in how we schedule, treat, and follow up our asthma patients

Do

Study Act

Plan

PDSA WORKSHEET

PLAN: Briefly describe the test: Inservice training and mentoring of staff on new Puriton Bennett Renaissance spirometer How will you know that the change is an improvement? Staff will express confidence in ability to perform testing – PFT entries into EMR will dramatically increase What driver does the change impact? Using planned care approach to ensure reliable asthma care What do you predict will happen? Staff will learn quickly, equipment will perform well and our asthma action plans will reflect better objective data. PLAN

List the tasks necessary to complete this test (what)

Person responsible

(who) When Where 1.Calibrate and test new spirometer Barb 1/10/2010 Nursing 2.Schedule staff training day Barb 2/10/10 Office 3.Staff Inservice Barb 2/16/10 Office 4.Staff practice times Barb Ongoing Office 5. Mentor during testing at least once per staff member

Barb Month of Feb Office

6. Implement routine testing Staff 2/1/10 Office Plan for collection of data:

DO: Test the changes. Was the cycle carried out as planned? x Yes No Record data and observations. Good spirometry functioning – increased numbers of PFT into EMR What did you observe that was not part of our plan? Some reluctance by staff to learn/practice mostly due to time involved. Did schedule some early morning inservices, practice time with testing each other

STUDY: Did the results match your predictions? x Yes No Compare the result of your test to your previous performance: What did you learn? Importance of staff involvement ACT: Decide to Adopt, Adapt, or Abandon. Adapt: Improve the change and continue testing plan.

Plans/changes for next test:

Adopt: Select changes to implement on a larger scale and develop an implementation plan and plan for sustainability

Abandon: Discard this change idea and try a different one

Team Name: Southern Oregon Pediatrics Date of test:2/1/10 Test Completion Date: 3/1/10

Overall team/project aim: Spriometry teaching on asthma patients over 5yrs at initial assessment and rck 1-2 times/year

What is the objective of the test? Training of staff to accurately perform spirometry

What 90 day goal does the change impact? 90% of patients with optimal asthma care using objective assessment data

x

Do

Study Act

Plan

Pulmonary Functions and Medications

Asthma Class of Patient

Action Plan in Electronic Record

Our Registry

We show an improvement in our follow up appointments from 60% to over 90% but feel we still need to monitor changes we have made to continue success.

90-100% of our asthma patients over 6 months of age are recommended or receiving a flu vaccine.

Lastly, our percentage of patients receiving optimal asthma care has reached over 90% this last month.

Summary