Management approach stems peds admissions
One-on-one attention drives program success
The No. 1 cause for pediatric hospital admissions at Kaiser Permanente Oakland (CA) is asthma. Yet most of the admissions are avoidable when asthma is properly managed, says Caskey Weston, RN, pediatric asthma case manager at Kaiser. That's why the health care facility implemented a case management program for high-risk pediatric asthma patients one year ago.
Children who visit the emergency department (ED) or are hospitalized for asthma are automatically referred to Weston. Also, physicians can refer pediatric patients they determine to be at risk.
Although data at Kaiser have not yet been collected to determine the benefit of this one-on-one approach, a similar approach at Henry Ford Health System in Detroit saw a 50% reduction in hospital admissions and ED visits.
"Children are a higher-risk population than adults. They have less control, and they account for a higher percentage of our hospitalizations and ER visits. From a cost perspective, they are a more vulnerable group," says Roberta Eis, RN, BSN, MBA, project manager at Henry Ford.
What did these two health care systems set in place to help pediatric patients manage asthma? Following are the key elements of each program:
o One-on-one attention.
Although children diagnosed with asthma at Kaiser first are referred to the group asthma class along with their parents, those who are unable to control their asthma are case managed. Weston reviews much of the information covered in the class, such as asthma triggers and proper use of medication. The big difference is that she is able to discuss how it pertains to each child. Also, she is available to answer questions after the family leaves the education session.
At Henry Ford, all children ages 5 to 17 and their parents attend two to three individualized education sessions over an eight-week period taught by a registered nurse. The nurse follows a fact sheet and lesson plan so teaching is consistent throughout the system.
o Monitoring peak flow meter readings.
Each program teaches patients how to determine their "personal best" peak flow reading so they can monitor daily how well they are doing with the aid of an action plan. Once a personal best is established, patients then can adjust their medication daily depending on what "zone" they are in and seek medical attention when necessary. A color-coded monitoring system helps patients decide which zone they are in and what steps to take to manage their asthma.
The zones are:
- Green zone. No symptoms, take preventive measures.
- Yellow zone. Symptoms starting, take steps indicated in the action plan.
- Red zone. Serious symptoms that require medical attention.
o Patient follow-up.
After each pediatric education session is completed at Henry Ford, nurses ask families if it is all right to contact them in three months. The purpose of the phone call is to keep patients enthused about their asthma management plan. The follow-up phone call covers such issues as how often they are recording peak flow readings and how many days of school the child has missed due to asthma.
At Kaiser, Weston calls patients two weeks after their first clinic appointment to ask how well they are controlling their asthma. Then she calls once every one to three months, depending on their stability and compliance. Frequently, she calls a day after a teaching session in which the parents have received new information such as how to administer medication.
"Don't assume they understand what you are telling them," warns Weston. "Even people who are highly motivated and intelligent aren't able to think clearly when their child is sick."
[For more information on managing pediatric asthma, contact:
Roberta Eis, RN, BSN, MSA, Project Manager, Henry Ford Health System, Department of Clinical Services, Wing 4-F, 1 Ford Place, Detroit, MI 48202-3450. Telephone: (313) 874-6981.
Caskey Weston, RN, Pediatric Asthma Case Manager, Kaiser Permanente Medical Center, 280 W. MacArthur Blvd., Oakland, CA 94611. Telephone: (510) 596-1200.]
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