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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