Are you undertreating children with asthma?
Do all pediatric asthma patients receive relievers, corticosteroids, and a home management plan in your ED? These are three measures of care for which The Joint Commission is collecting data.
Although only children's hospitals, for the most part, are collecting those data, nurses in community EDs should take careful note of the requirements, says Jerod M. Loeb, PhD, The Joint Commission's executive vice president for quality measurement and research.
"While children's hospitals have been very carefully paying attention to this for some time, I would like to see a trickle-down effect to the general hospitals," he says. "Asthma is a big reason for visits to the ED in both children's and general hospitals. If we can improve care by making sure that each patient gets the right guideline-based care every time, that is a good thing, whether the hospital is collecting data and transmitting it to us or not."
Home management plan required
Though compliance rates are "exceedingly high" for relievers and corticosteroids, Loeb says that he expects to see lower compliance rates for the measure requiring patients to be given a home management plan. "I'm guessing the numbers will be lower, because that's sort of pushing the envelope," he says. "What these measures really address is preventable trips to the ED and, worse yet, preventable inpatient admissions."
If your care of children with asthma is guideline-based and you can get parents to understand the importance of home management, "you can avoid that trip to the ED and improve access as well," says Loeb. "A lot of times, ED throughput gets clogged up because there are people coming in for nebulizer treatments and other kinds of things associated with asthma care. The real impetus behind all this is to prevent the ED visit in the first place."
The Joint Commission's asthma measures are used as benchmark standards for pediatric asthma patients, says Stephanie Haler, RN, manager of the ED at Clarian North Medical Center in Carmel, IN. "We track each asthma patient that is seen each month and review their care to ensure we have met the standards," she says. "When we don't, we immediately begin looking at ways to improve our practice and then rapidly implement changes."
If a child's asthma is in good control, they should not need the ED and should need only minimal use of their rescue inhalers, adds Haler. "Our goal is to keep kids healthy so that they do not have a crisis which precipitates them coming to the ED," she says. "The best way to do this is education on the child's medications and dosing regimens, avoidance of triggers, and home monitoring such as peak flows."
Do all pediatric asthma patients receive relievers, corticosteroids, and a home management plan in your ED? These are three measures of care for which The Joint Commission is collecting data.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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