Improving Asthma Care for Children - the eAAP
The Children's Hospital at Westmead
This project aimed to increase the documentation and documented provision of an Asthma Action Plan (AAP) to children discharged with asthma from The Children's Hospital at Westmead.
An electronic AAP was introduced in April 2008. The evaluation consisted of a review of the electronic medical record, comparing 2007 with 2008 and a staff satisfaction survey.
The electronic AAP significantly increased the number of recorded AAPs and patients discharged with a recorded AAP.
View a presentation ( pdf - 663 KB) on this project given at the 2009 NSW Health Awards.
Listen to the recording of this presentation ( mp3 - 9.4 MB)
A multidisciplinary team, comprising representatives from ED, Respiratory Medicine, Asthma Education Service and the Clinical Applications Support Unit (CASU), decided on the following actions after further discussions with key stakeholders.
- Design and implement an electronic AAP (eAAP) that would be completed in Powerchart and automatically become part of the electronic medical record (eMR). A business case was prepared for and supported by CASU.
- Trial this eAAP in ED.
- Design and implement a training package for the eAAP that would also increase general awareness of the need for an AAP.
- Evaluate the implementation by reviewing the Powerchart eMR and ED Health E-Care, comparing outcomes to the previous year, and by surveying staff.
The eAAP was developed as a Powerform in Powerchart (Figure 1) using a drop down box and click format. Choices in the boxes were agreed by the team to encompass all possible realistic clinical combinations.
Time was taken to ensure that when the Powerform was printed it looked like a conventional AAP, with additional information on page 2. Download a sample printout ( pdf - 47 KB).
A training package was designed using practise patients in Powerchart to demonstrate how to use the eAAP and to reinforce the need for an AAP for patients discharged with asthma.
A poster was designed to be used in the clinical areas (ED, wards and outpatients), Figure 2.
After an intensive education program the eAAP was first used in ED at the start of Term 2 2008 (21 April 2008) and due to positive feedback was then rolled out to the wards and outpatients clinics.
The number of AAPs recorded in Powerchart increased by 816%, from 232 in 2007–8 to 1895 in 2008–9.
Health E-Care records were reviewed before (30/4/2007–21/10/2007) and after (21/4/2008–19/10/2008) the introduction of the eAAP. All patients with a discharge diagnosis of asthma were reviewed and a subset of those discharged from ED were analysed. 850 patients in the first and 873 in the second six months were included in the study.
The number of AAPs either recorded in the eMR or mentioned in the eMR as being pre-existing or being given (ie patients discharged from ED with an AAP) increased from 20% to 79% (p<0.001).
A convenience sample of 64 ED, General Medicine and Respiratory doctors completed the feedback survey.
Respondents scored statements on a ten point Likert scale according to degree of agreement (10=maximum agreement). Respondents were asked questions on their current use of the eAAP and the majority scored it very highly.
Respondents were also asked to rate the eAAP against the old intranet version, the majority rating it superior.
The current eAAP can be used in any institution that currently uses Powerchart, and CASU are able to make this available to any hospital or Area Health Service that requests it.
The eAAP will soon include an educational tool as part of the Powerform so that staff receive instruction on what to include as they fill in the form.
Emergency Department, The Children's Hospital at Westmead
Phone: 02 9845 2467