American Lung Association 27 th Annual Respiratory Care Conference Asthma Response Team Clifton Dennis, RRT, AE-C.

American Lung Association27th Annual Respiratory Care Conference

Asthma Response Team

Clifton Dennis, RRT, AE-C

Pediatric Lifetime and Current Prevalence

Georgia 38 States0

2

4

6

8

10

12

14

16

18

Lifetimecurrent

Pediatric Asthma Prevalence

0-4 years 5-9 years 10-14 years 15-17 years0

2

4

6

8

10

12

14

16

Georgia38 States

Pediatric Asthma By Sex

Boys Girls0

2

4

6

8

10

12

14

16

Georgia38 States

Pediatric Asthma By Race/Ethnicity

White Blacks Hispanic Other Multirace0

2

4

6

8

10

12

14

16

18

20

Georgia38 States

Pediatric Asthma Hospitalization Rates

0-4 yrs 5-9 yrs 10-14 yrs 14-17 yrs0

50

100

150

200

250

Georgia

Asthma Deaths

White Black Other0

5

10

15

20

25

30

GeorgiaUnited States

Pediatric Asthma Deaths CSRA 1999-2006

1999 2000 2001 2002 2003 2004 2005 20060

0.5

1

1.5

2

2.5

3

3.5

4

4.5

Asthma Response Team responsibilities

Introduction and explanation of why we are here Complete ART encounter form Initial PEF, FVC. FEV1 Will determine severity based on EPR-3 guidelines for this admission Review two week history of symptoms to determine severity Review one year history to determine risk Review asthma disease and the asthma process provide asthma booklet/packet Explain the use of Quick Relievers and Controllers

1. Review albuterol use 2. Review ICS usage 3. Review MDI/DPI usage with demonstration

Review triggers- Mention smoking cessation 1. Trigger avoidance 2. Ozone trigger 3. Encasements- available through CMS if qualified

Review spacer with/without mask 1. Provide adults with spacer 2. Provide children with spacer /mask in Asthma Kit

Review peak flow meter usage 1. Teach proper peak flow 2. Label peak flow meter with predicted values

Insure follow up appointment is made prior to discharge 1. Specialist appointment is recommended for high risk, moderate to severe patients 2. Intermittent to mild may follow up with PCP May use MCG continuity Clinic@ 721 -2143 from 8-4:30 as walk in if needed

Complete Asthma Action Plan- Utilize GREAT for asthma action plan. Will require parental signature 1. 1- copy to parent/patient 2. 1- copy for medical records (signed copy) 3. 1- copy for ART team 4. This will be faxed to school nurse and PCP if applicable

Provide Asthma kit, spacers & peak flow meters Document whom provided ART services, equipment used and serviced provided by the ART team member.

Asthma Response Team Encounter Form

Patient Information

Clinical asthma severity score (CAS) Score Visit Information

Patient label

Race Triage score Visit date

Gender 30 minute score

Primary care MD

Patient name 1 hour score School

Date of birth Discharge Score

County

Age Inpatient admit score

Zip code

Height PICU admit score

Emergency room physician

Predicted Peak flow Reason for visit Actual PEF Severity of Asthma Classification FEV1 Well controlled Intermittent FVC Not well controlled Mild persistent Very poorly controlled Moderate Severe Persistent Impairment # of days in past two weeks Past Asthma History ( Risk) Coughing # of visits to ER for asthma in past 12 mos. Wheezing # of office visits for asthma last 12 mos.

Trouble breathing # of hospital admissions for asthma (2/yr persistent)

Limited activities # of ICU admissions for asthma (1=persistent)

Awaking at night # of times oral steroids have been used in 12 mos. ( more than 2 /yr = persistent asthma)

Use of quick relievers

Current Medications PO Jet MDI DPI

Albuterol ( Proair, Ventolin,Proventil)

Levalbuterol ( Xopenex) Cromolyn, Intal, Tilade

Inhaled Steroid ( Flovent, Pulmicort, Qvar,Areobid,Asmenex)

Oral steroid ( Prednisone, Deltasone, Prednisolone, Decadron, Prelone, Pedipred)

Leukotriene modifiers ( Singulair,Accolate,Zyflo )

Services Provide by ART Team member Supplies provided to patient

Nebulizer Treatment Peak flow meter MDI treatment Spacer with mask DPI treatment Spacer without mask Education Asthma Kit Home Phone #_________________________________________________________________________________ Cell Phone# ___________________________________________________________________________________ Alternate # ____________________________________________________________________________________

Residence Counties

Richmond county

Aiken County Columbia County

Edgefield County

0

20

40

60

80

100

120

140

160

180

200

Children's Medical Service Enrollment

CMS0

20

40

60

80

100

120

55

86

103

Asthma PACK

Asthma Classification

intermittent mild persistent moderate persistent severe persistent0

20

40

60

80

100

120

Health Care Utilization

Avg. E

D visit

s

Avg. P

CP visit

s

Avg. H

ospi

taliza

tions

Avg. P

ICU ad

miss

ions

0

0.5

1

1.5

2

2.5

32.5

2

1

0

Average CAS by location

initial score 30 min score

1 hour score

Discharge score

Inpatient score

PICU score0

1

2

3

4

5

6

7

5

4

3

1

3

6

Patient Disposition

0

50

100

150

200

250

3

24

217

5

PICUInpatientED Discharge7 day return

Metrics

Teamwork Award for ART team

References

• Introduction: Enhancing the role of the emergency Department in the identification and management of childhood asthma: Rechelefsky, Kennedy, and Stone Pediatrics 2006

• Expert Panel Review number 3, NHLBI, 2007• Behavioral Risk Factor Surveillance System,

(BRFSS) CDC ,2008