P2.N277: Improving Asthma Control in Pediatric Patients by Including an Asthma Action Plan in a Large Urban Safety Net Hospital: A Quality Improvement Project

Purpose/Objectives: Asthma is a condition characterized by chronic inflammation in the airways that cause recurrent episodes of breathlessness, wheezing, and chest tightness and is a significant cause of morbidity and mortality. Asthma Action Plans (AAP) are intervention tools to assist patients and parents to control asthma by outlining the medications to manage the condition, recognize exacerbations, and identify signs of when to seek help. Previous studies have showed that using AAPs have increased patient’s knowledge of their condition, improved their asthma control, and decreased hospitalizations. Our baseline data showed that only 18% of pediatric patients were receiving the AAP in the inpatient unit as part of their discharge handouts. A quality improvement project was initiated to improve the inclusion of an AAP to their discharge instructions.

Objective:
To improve asthma control in the pediatric inpatient unit of patients aged 2-21 years by including the AAP from 18% to 80% in 6 months with the primary diagnosis of asthma.

Design/Methods: The Electronic Medical Record (EMR) EPIC at our hospital can attach the AAP to a patient’s discharge instructions. The inclusion criteria were all children aged 2 to 21 years of age with the primary diagnosis of asthma. A series of interventions with multiple Plan-Do-Study-Act (PDSA) cycles are being conducted. The first was 1:1 education of the pediatric residents in the inpatient unit. The second was placing a poster in the resident workroom, which acted as a constant reminder; the third was sending a mass email to all of the residents demonstrating the importance of including the AAP on how to include the it to the patients’ discharge instructions. The EMR of the patients were periodically reviewed to see the outcome of our interventions. The results were interpreted in a run chart to analyze how successful the interventions were throughout the study period. The study was approved by the IRB of the hospital.

Results: The first intervention PDSA #1 with resident education yielded a significant increase in AAP completion to 75%. With the introduction of PDSA #2 as a displayed poster in the resident workroom, we observed a slight decrease in AAP completion to 71%. AT PDSA #3 cycle, as a mass email sent to the pediatric residents, we reached a steady rise with the AAP completion above 80%, and are maintained at >80% over the surveillance period. There were no readmissions in children with the primary diagnosis of asthma.

Conclusion/Discussion: A series of successfully planned interventions increased the completion of AAPs in children with a primary diagnosis of asthma from 18% to above 80% in an urban safety net hospital.