Asthma in a Minute: Tool Kit for asthma self-management education - PowerPoint PPT Presentation

Asthma in a Minute: Tool Kit for asthma self-management education School Nurses can teach key asthma lessons, one minute at a time Dottie Bardon, BSN, MEd, RN, NCSN LaSalle Springs Middle School Rockwood School District April 19, 2018

Why does it matter? Asthma remains the most prevalent chronic condition affecting students of all ages. [CDC, 2012]

What is the EPR3?  Expert Panel Report of 2007, defines the Guidelines for Diagnosis and Management of Asthma  The “gold standard” of asthma care, from the National Institutes of Health, and National Asthma Education and Prevention program  Advocated by Missouri Asthma Prevention & Control Program [NHLBI, 2007]

EPR3  Accepted protocol for asthma care & education  Step-wise medication protocols should guide prescribers  Potentially will be linked to third party re-imbursement

EPR3 Four Main Components: 1. Measurable assessment of asthma severity 2. Medications prescribed according to a step-wise protocol, emphasizing Inhaled Corticosteroids [ICS] for persistent asthma 3. Control of environmental factors 4. Education of patients

Asthma Education: “teach and reinforce key messages at every opportunity.”  Effective education is a partnership between the clinician and the person who has asthma  Self-management improves outcomes [urgent care visits, perceived control of symptoms, quality of life]  Cost-effective use of professional time  Reduces school absenteeism  Every encounter, for every reason, should include some element of asthma education  Repetition and reinforcement are essential [NHBLI, 2011]

EPR3 Key Educational Messages  Basic facts about asthma: airways, pathophysiology  Self-monitoring to assess control and recognize signs of worsening asthma  Role of Medications: understanding the difference between  Quick-relief medications  Long-term control medications  Taking medications correctly  Avoiding environmental factors that worsen asthma  Develop a written asthma action plan

Time is always the barrier…how can we make use of brief, teachable moments?  Use the minute between two puffs!  When do school nurses see students with asthma? 1. Before PE 2. When they are symptomatic 3. When they bring a refill 4. Every other reason for a health office visit!

Minutes add up, but we don’t always count them…  We do this routinely, spontaneously, but seldom track the lessons or document short snippets as “education”  Will it make a difference? Pre and post tests measure knowledge and self-efficacy  Ever wonder if asthma is a convenient “get out of class” excuse? Capturing assessment data and teaching a mini-lesson make every encounter worthwhile!

Asthma in a Minute  Checklist : teaching outline for school nurse  Chart: capture airflow data to share with PCP  Cards: student collects as incentive & reminders

Space for self-care

Tools  Peak Flow/ Forced Expiratory Volume meters  Inhaler technique teaching device  Asthma in a Minute Checklist, Chart and Cards  Poster of lungs & airways  Model of airway  Poster of medications  Use what you have!

Teaching Checklist  Basic asthma facts  Self-Monitoring  Medications  Triggers  Asthma Action Plan

Checklist: measurable outcomes  Pre & post tests: asthma knowledge questionnaire  Asthma Control Test: five questions, scale 1-5  Getting as much done as you want?  Shortness of breath?  Symptoms at night?  Used quick relief inhaler?  How would you rate control?

Basic Asthma Facts  1. Respiration 101, lungs and airways  2. Airways with asthma*  Constriction  Inflammation  Mucous

Self-monitoring  3. Recognize symptoms, day & night  4. Measure airflow: exhale HARD & FAST *  5. PEF/FEV1 skill check: coach a classmate

Medications  6. Quick relief inhalers: help in a hurry  7. Control medication: ICS every day to prevent  8. Other medications prescribed for you  9. MDI use: inspiratory device, inhale SOFT & SLOW *  10. Spacer or holding chamber: delivers med better  11. Nebulizer: delivers the med differently  12. DPI [dry powder inhaler]  13. Inhaler skill check: coach a classmate

Triggers  14. Allergens and irritants, at home and everywhere*  15. Exercise-induced bronchospasm [EIB], activities and sports

Asthma Action Plan  16. Calculate your personal best numbers*  17. AAP: use what they were given, or suggest a plan  18. Bonus topic, review or new!

Assessing Airflow: Chart it! Capture the data  electronic record  on paper Share with  Parents  PCP

Collect the Key Cards  Younger students enjoy choosing the ring  Take advantage of small group competitive spirit  18 cards covering the outline, includes one “bonus” wild card  Tweak as you like! words, pictures…your style

Keys to Asthma Control  Index cards listing brief reminder of the topic  Gather on a key ring, stored with the student’s MDI at school  Student will eventually take home as a visual reminder  Nurse and student can quickly see where they are on the education plan, as a checklist or posted on wall  If needed, additional time can be allocated with teacher collaboration

Peak flow/FEV monitors  What’s the difference between PEF and FEV1?  FEV1 is considered the objective “Vital Sign” of asthma status  P eak E xpiratory F low measures HOW FAST the air is moving  F orced E xpiratory V olume in One Second measures HOW MUCH air is exhaled, in liters

Practice makes Perfect

Teaming Up for Asthma Control [TUAC]

Get started…and keep going!  Start small, with a subset of students who routinely use MDIs at school  Adapt to any age level, but “spiral” the lesson to continually reinforce the key messages over time  Consider using students as peer leaders/teachers to present the concept to the younger class

Resources  Missouri Asthma Prevention and Control Program  Teaming Up for Asthma Control [TUAC]  University of Missouri-Columbia  Asthma Ready Communities [ARC]  Asthma-Friendly Schools  Missouri Department of Health [Missouri Asthma Prevention & Control Program, 2014]

References  Centers for Disease Prevention and Control (2012). National asthma control program: Asthma fast stats. Retrieved from http://www.cdc.gov/asthma/NACP.htm  Missouri Asthma Prevention and Control Program (2014). Issue brief: Teaming up for asthma control, an outlook/analysis by urban and rural school zip codes. Retrieved from http://www.health.mo.gov/living/healthcondiseases/chronic/asthma/ pdf/TeamingUpforAsthmaControl.pdf  National Heart Lung and Blood Institute (2007). National asthma education and prevention program: Expert panel report 3, guidelines for the diagnosis and management of asthma, full report. U.S. Department of Health and Human Services. Retrieved from: https://www.nhlbi.nih.gov/files/docs/guidelines/asthgdln.pdf  National Heart Lung and Blood Institute (2011 update). Summary report, national asthma education and prevention program: Expert panel report 3, guidelines for the diagnosis and management of asthma. U.S. Department of Health and Human Services. Retrieved from: http://www.nhlbi.nih.gov/health-pro/guidelines/current/asthma- guidelines

Ahmad, E. & Grimes, D. E. (2011). The effects of self-management education for school-age children on asthma morbidity: A systematic review. The Journal of School Nursing, 27(4), 282-292. doi: 10.1177/1059840511403003 Coffman, J.M., Cabana, M.D., Yelin, E.H., Yelin (2009). Do school-based asthma education programs improve self-management and health outcomes? Pediatrics, 124 (2), 729-742. doi: 10.1542/peds.2008-2085 Engelke, M. K., Swanson, M., & Guttu, M. (2013). Process and outcomes of school nurse case management for students with asthma. The Journal of School Nursing, 30 (3). doi: 1059840513507084 Hester, L. L., Wilce, M. A., Gill, S. A., Disler, S. L., Collins, P., & Crawford, G. (2013). Roles of the state asthma program in implementing multicomponent, school ‐ based asthma interventions. Journal of School Health , 83 (12), 833-841. doi: 10.1111/josh.12101