AAAAI School Based Asthma Management Program A Sneak Peek at SAMPRO. Evilia Jankowski, MSA, BSN, RN President Michigan Association of School Nurses

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1 AAAAI School Based Asthma Management Program A Sneak Peek at SAMPRO Evilia Jankowski, MSA, BSN, RN President Michigan Association of School Nurses 1

2 Objectives Understand AAAAI School-Based Asthma Management Program Name the four components of SAMPRO Identify Summit Recommendations 2

3 AAAAI Summit October 2015 American Academy of Allergy, Asthma and Immunology Office of Schoolbased Management for Asthma National Association of School Nurses School-based Asthma Management Program 3

4 Group 1:Clinician Role of Clinician Child Asthma Action Plan Emergency Treatment Plan School Family 4

5 Group 2:Implementation Implementation Receipt Processing 5

6 Group 3: Education 6

7 Group 4: Environmental Triggers SCHOOL HOME 7

8 Group 5: Sustainability Dissemination 8

9 Components for SAMPRO Circle of Support Asthma Management Plan Asthma Education Assessment and Remediation of Triggers 9

10 Component 1: Circle of Support 10

11 Role of Clinician Annual Pre-school Physical Medication Triggers Inhalers/Spacers Asthma Action Plan Medication forms Other Responsibilities Educate Families Support School Nurse 11

12 ASTHMA VISIT CHECKLIST FOR THE PROVIDER Table 2 Table 3 ASTHMA VISIT CHECKLIST FOR THE CHILD AND FAMILY 12

13 Role of School Nurse Nursing Process Assessment Health History Asthma History Triggers Medications Hospitalizations ED Visits Id Students with undiagnosed asthma Chronic Absenteeism PE Participation Persistent Respiratory concerns Care Coordination Implement AAP 13

14 Table 4 SCHOOL NURSE ASTHMA CARE CHECKLIST (NASN) 14

15 School Nurse Asthma Care Checklist 15

16 School-based Asthma Management Essential Elements ID students with asthma Program Registration paperwork that includes health condition information AAP from the healthcare provider Parent s verbal acknowledgement of asthma Inhaler found in the student s backpack Acute flare up during the school day Confirmed diagnosis 16

17 School-based Asthma Management Programs School Nurse Triage for Care Coordination ACT Manage accessibility of quick relief medication Unlicensed Assistive Personnel medication training Monitor use of quick relief medication Bidirectional communication with Asthma Care Provider Promote Asthma Friendly Schools 17

18 Component 2: Asthma Management Asthma Action Plan for Home and School Plans (AMP) Asthma Emergency Treatment Plan 18

19 19

20 Community Resources School Based Health Centers Mobile Clinics 20

21 Outcomes Associated with AAP Current Outcome Measures Fewer deaths Fewer ED visits Improved School Attendance Performance 21

22 Component 3: Asthma Education in SAMPRO Essential components of asthma education Epidemiology Pathophysiology Asthma Action Plan Symptoms Triggers Asthma medication Signs of asthma episode 22

23 Asthma Education Students With Asthma Without Asthma Administrators Administrative staff UAP Teachers Teachers Aids Custodians Playground Supervisors Cafeteria Staff PE Teachers Coaches Transportation Administrators Bus Drivers 23

24 SUPPLEMENTAL TABLES S3-S7 24

25 School Nurse Education Current knowledge of asthma basics including: Pathophysiology Epidemiology Signs and symptoms of exacerbations mild to severe Triggers and environmental management Medication therapy Proper technique Mechanism of action 25

26 Online Asthma Resources AAAAI School Nurse Asthma Toolbox aaaai.org/sampro eschoolcare son.wisc.edu/eschoolcare.htm National Certified Asthma Educator 26

27 School Nurse Asthma Management Skills ASSESSMENTS SURVEYS IDENTIFICATION ASTHMA ACTION PLANS ENSURE MEDICATION AVAILABLE ASSESS/TEACH ASSESS SELF-CARRY ABILITY OBTAIN ORDERS AND CONSENTS TRAIN UNLICENSED SUPPORT STAFF ESTABLISH AND MAINTAIN COMMUNICATION MONITOR ABSENTEEISM PARTICIPATE IEP/504 PLANS ADVOCATE by becoming engaged in the development of protocols (e.g., treatment and emergency care) 27

28 Component 4: Addressing Environmental Triggers Integrated Pest Management Low- emitting Products Indoor Air Quality Protocols Environmental Education for Staff 28

29 IAQ TOOLS FOR SCHOOLS ACTION KIT 29

30 Healthy School Environment 30

31 Empowering the School Nurse to Advocate for Environmental Change Advisory Team/CSHT Community Members School Staff Custodian Parent Staff School Nurse School Administrator Nutrition Service Member 31

32 Outcomes of Environmental Action Reduction of exposure to triggers Objective measures to determine reduction of exposure to triggers Improved health outcomes Evaluation of any direct correlation in these reductions to improved health outcomes 32

33 IMPLEMENTATION, DISSEMINATION, SUSTAINABILITY: PROGRAM FIDELITY AND ASSESSMENT 33

34 Model Legislation HR4662 Four components of SAMPRO : 1) School Asthma Treatment Plan including 1) Enforcement of existing self-carry policies 2) Stock albuterol and a means to deliver (valved holding chambers) 2) Asthma Action Plan that includes medical authorization for administration of asthma medications in school and self-carry (Individual Medication Authorization) 3) Comprehensive asthma educational plan for all school personnel including administrators, staff, nurses, teachers and coaches 4) A plan for assessment of the school environment and remediation of school-based asthma triggers * A plan for communication between clinicians, school nurses and families that is HIPAA and FERPA compliant. 34

35 Stewardship Website Patient materials available English/Spanish Registration to participate in SAMPRO help the AAAAI and NASN track utilization confirm agreement to terms of use facilitate follow up communication provide outreach for technical assistance 35

36 Dissemination and Adoption Adoption Facilitated by Office of School-based Management of Asthma Dissemination National legislation Organizations CDC State School Nurse Consultant School District Nursing Supervisor State or Regional Asthma Coalitions State Chapters of the American Academy of Pediatrics State affiliates of the National Association of School Nursing Departments of Public Health State Asthma Plans Coordinated School Health Programs 36

37 Assessment and Implementation Fidelity 1) Dissemination of a sustainable program 2) Program fidelity 3) Must be of value to the school nurse 1) Must be associated with a low burden for implementation and reporting 4) Must have sufficient flexibility without losing fidelity 1) Time required by nurse to administer proper asthma care and education = time student is away from classroom 5) Data reports standardized across school based asthma programs to reduce burden 37

38 RE-AIM 38

39 Conclusion Circle of Support Asthma Management Plan SAMPRO Asthma Education Plan Assessment and Remediation of Triggers 39