NEISD Asthma Awareness Education Program

Transcription

1 NEISD Asthma Awareness Education Program North East Independent School District: A large urban school district in San Antonio, Texas 66,770 students (pre K-12) ; 8800 employees 67 traditional campuses, 14 Magnet Programs Registered Nurse (RN) for every campus. More than 8,000 students with Asthma (12% of student population) 1 Registered Respiratory Therapist (RRT), Certified as Asthma Educator (AE-C) Program created in 2006 utilizing a 4 component approach to Asthma Disease Management (NHLBI EPR 3)

2 Asthma Management: A priority for Schools In a classroom of thirty, 3 students are likely to have asthma. NEISD asthma Prevalence Rate 12% 18% In the US, more than 7 million children have asthma. Asthma management in schools can be addressed through a two-pronged approach: Creating a comprehensive asthma management plan Establishing an environmental assessment plan The added plus: Student performance and teacher and staff productivity can be improved by managing the environmental quality of school facilities. Of the absences caused by chronic conditions, asthma is one of the biggest contributors, causing 10.5 million missed school days annually.

3 Asthma Asthma Management is. Environment Inducers : dust mites, cat dander, cockroaches, mold, ETS Genetics Asthma Development Medication NHLBI guidelines, adherence and technique Costs: Loss of instruction time (to clinic for med) Asthma Asthma classroom Control Loss of focus in Symptoms Loss of attendance A normal, active EMS calls life Death Environment Environment "Our genes may load the gun, but the environment pulls the trigger." Ellen Silbergeld, Ph.D. Reduction of Triggers and Co-morbid conditions (allergy, reflux, obesity)

4 Environmental Impact on Health of Students Asthma/Allergy Symptom Threshold Cumulative Effect of Asthma Triggers Diane Rhodes RRT AE-C inflammation / symptom development Symptom Threshold met Symptoms develop (PRN usage needed) irritants allergens irritants allergens situation 1 situation 2 ( allergy induced ) infection irritants allergens situation 3 ( infection induced ) infection irritants allergens situation 4 (goal) No symptoms seen, yet inflammation exists Threshold met Threshold met Impact of Asthma Triggers allergens irritants infection Exposure reduction measures taken, infection does not provoke symptoms

5 VALUE PROPO$ITION: Asthma Program BOLD GOAL: program is focused on creating healthy learning environments for all students, including reducing asthma triggers, through comprehensive indoor air quality and asthma management. In the first year and for an input cost of $63,000, the program will reduce the number annual average school days missed by students with asthma from 8 to 7. This cumulative effect of a one day reduction in absenteeism by over 8000 asthma students will generate $267,552 in state revenue for North East Independent School District. Within 5 years we will change the culture, reduce absenteeism due to asthma by 50% generating $1 million in revenue gains each year, and will decrease the amount of lost academic instruction time due to asthma symptoms; ensuring students with asthma may achieve their full academic potential. Healthy Children Learn Better Costs of doing nothing

6 Bring an understanding of prevalence and assess needs to improve processes district wide: School District impact: Funding/Performance Quality of Life Surveys Raise parent expectations Staff disease awareness Recruit champions (custodial, nurses, PE staff, administrators ) Data, data, data Return on investment Assess culture; reduce environmental risks: Walkthroughs: Remove triggers from school environments Indoor environment quality best practices TfS Six Technical Solutions Tips for Healthy Learning Environment Symptom threshold Standardized Environmental Assessment Facility scores feedback NEISD Asthma Awareness Education Program DASHBOARD Awareness Environment O r g a n i z e Asthma Control C o m m u n I c a t e Stakeholders: students, parents, staff, community Medication & Tools Education Provide tools/resources to reduce health care barriers: Emergency Nebulizer Policy Asthma Action Plans (ALL meds) NHLBI EPR 3 guidelines/ 6 priority messages Logic Model Health Check data PRN usage tracking Inspiratory flow assessment Self-Carry Timeline curriculum Referral mechanism Identify gaps; provide disease management strategies to stakeholders to improve quality of life: Webinars/Podcasts to admin Staff development Symptom threshold Parent activities: PTA, ABO Student/Staff Activities- Asthma Obstacle Course Curriculum: Asthma and Environmental Quality AIMS Asthma: Incentivizing Management Skills

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8 Quality of Life Survey Awareness Component: Bring an understanding of prevalence and assess needs to improve processes district wide Target Population: students with asthma (6000) Input: 1 FTE (Asthma Educator), NEISD research department staff member (3 hours) Activities: plan QOL asthma survey, assess students QOL, family burden/barriers (handout or online), evaluate results Outputs: identified campus outliers and at risk populations: absenteeism, % of uncontrolled asthma, ER visits, limited activity, visits to clinic (classroom interruption) Outcomes: Communicate results, campus/admin buy-in, policy changes, new policies, staff education on asthma triggers, asthma letter (welcome packet), Tips for Teachers Impact: targeted outreach asthma education to community and bringing healthcare providers to NEISD families, increase asthma awareness, attendance, control symptoms, and increase student performance

9 EMS calls- Nebulizer protocol Medication Component - Provide tools/resources to reduce health care barriers Target Population: students with asthma with no medication or not responding to personal medication in clinic (8000) Inputs: compressor/campus capital outlay ($2000), supplies and albuterol (1.49/treatment) as needed Activities: assess EMS calls/transports data, organize policy to close health care gaps (HS, MAC), Outputs: provide an albuterol treatment for students who meet criteria, provide earlier intervention to reverse/minimize symptoms Outcomes: decreased EMS calls, decreased EMS transports, decrease risk of death due to asthma, improve continuity of care with primary asthma physician Impact: parents see NEISD as a partner and establishes a coordinated approach to asthma management, reduces cost of ER visit for parents, increases academic instruction time, attendance and student performance.

10 Tracking PRN data Medication Component - Provide tools/resources to reduce health care barriers Target Population: asthma students with quick-relief medication on campus Input: 1 FTE AE-C Activities: Assess nurses data for clinic visits for quick relief inhaler use Outputs: Nurses to isolate symptom driven (PRN) inhaler use from scheduled symptom inhaler use. Track # PRN use to determine loss of classroom time due to symptoms occurring during the school day/classroom Comparison of Inhalers/Nebulizers Inhalers Inhalers Nebulizers Nebulizers Aug/sept Outcomes: Identify campus with outliers in PRN usage. Increase IAQ investigations driven by health of students. Removal of stuffed animals, fragrances, wall-wall carpet, residential animals from classrooms. Communicate IAQ improves health of students and decrease clinic visits, identifying uncontrolled asthma (> PRN use 2 times/week) earlier Impact: Development of electronic medical record (Healthcheck), Tracking asthma and IAQ symptoms to classroom where symptoms developed. Understanding Reaching Symptom Threshold of administrators and staff, Proactive asthma management vs reactive, strategic use of facilities maintenance resources

11 Asthma Obstacle Course Education component: Identify gaps; provide disease management strategies to all stakeholders to improve quality of life of those with asthma Target Population: all campus staff, students, families Input: 1 FTE AE-C, grant of $1500 (props) Activities: plan hands-on asthma awareness education with a strong environmental component. Principals experiencing AOC Outputs: increase # of teachers informed on asthma triggers, experience symptoms that follow trigger exposure (set up during school day), and airway changes Increase # of Families understanding the pathophysiology of asthma, triggers, medication actions (wellness/health fairs) Outcomes: increase in staff trigger awareness/ IAQ best practices, trigger cause and effect, classroom self-assessment, increase asthma awareness, triggers, & symptoms to general population Impact: Change in Culture: Asthma friendly classrooms/disease management. Reducing clinic visits and increase classroom instruction time. Teachers conceptualize healthy environments

12 Teacher Self Assessment of Classroom Environment

13 Environmental Assessments Environment component: Assess culture and reduce environmental risks Target Population: all environmentally sensitive students & staff (asthma, allergy, migraines, chemical sensitivity, etc.) Input: 1 FTE Indoor Air Quality, 1 FTE AE-C Activities: campus assessment Environmental Health issue (submitted by campus via Electronic work order system), Healthcheck data driven classroom assessments, routine assessment of campus (walkthrough), distribution of Tips for Healthy Learning Environments Outputs: Track # PRN use to determine origination of possible trigger location (classroom, building), remove triggers, IAQ assessment standards, training of teachers/administrators/ custodians, communicate Symptom Threshold philosophy, Pollen count tracking Outcomes: Identify campus and classrooms with outliers in PRN usage, increase in IAQ investigation requests, communicate IAQ benefits (improve health of students and decrease clinic visits), reduce maintenance costs (ex water intrusion events), end of year clean-out Impact: Development of electronic Environmental Assessment software application, CHANGED CULTURE, IAQ/Asthma in parent/student manual, facilities staff buy-in, administrator buy-in, additional IAQ staff member, Symptom Threshold understanding

14 Teacher Tips Given to teachers who have students with a diagnosis of asthma in their classroom Goal is to ensure students with asthma can achieve full academic potential by; Decreasing asthma /allergy symptoms Reduce disruption of classroom instruction time Alleviate a potential emergency situation Proper asthma management involves Access to MEDICATION ENVIRONMENTAL trigger reduction

15 Bold Goals Value Proposition Overview Asthma Friendly Environments & Disease Management Policies Capture State Revenue: Potential Revenue Gains Reduce Loss of Academic Instruction Time

16 Attendance Funding Return on Investment Number of asthmatics in NEISD schools % Average number of school days missed by those with asthma Attendance daily rate by state Potential revenue LOST 8,361 (CDC) 8 $32.00 $2,140, Benefits possible when asthma/allergy control environmental measures applied: Reducing average number of schools days missed of those with asthma by 50%... Improving all asthmatics attendance by only ONE day. $ 1,070,208.00/year $ 267,552.00/year

17 PRN Inhaler Use = Loss of Academic Instruction Time In clinic, nurse assesses (symptoms, history, etc) Gives inhaler, (2 puffs 1 min apart) Wait time for med to work Reasses student Variable ### In many instances, a second dose is required if student symptoms have not completed subsided at time of reassessment. In this case an additional 20 minutes of wait time is required before administration of 2 nd dose. Student symptomatic during class, notifies teacher walks to clinic* Total Academic Time Lost 26 min 5 minutes 4 minutes Send back to class if symptoms clear Asthma is an individual disease and responses to medication vary. This example is a best-case scenario in which a student responses appropriately to the first administration of quick relief inhaler and can promptly return to class. * Buddy system used to escort to clinic

18 Elementary Campus Comparison Benefits to Campus Tips E Over for Healthy Next Two Classroom MonthsAir IAQ influences PRN Inhaler Use After utilizing Tips for Healthy Classroom best practices (Similar size, area, building age, demographics) Can you indentify which campus was NOT following best practices? P R N i n h a l e r u s a g e Campus A. Campus B. Campus C. Campus D. Campus E. Campus A. Campus B. Campus C. Campus D. Campus E. Aug/Sept October November December January February March Aug/Sept October November December January

19 IAQ BEST PRACTICE Reduces PRN Inhaler Use Benefits to Campus E Over Next Two Months After utilizing Tips for Healthy Classroom best practices 180 P R N i n h a l e r u s a g e Aug/Sept October November December January February March 0 Campus A. Campus B. Campus C. Campus D. Campus E.

20 Reductions in Loss of Academic Instruction Time after IAQ Best Practices Applied January 26 minutes 176 PRN visits 4576 minutes 76 hours February 26 minutes 106 PRN visits 2756 minutes 50 hours March 26 minutes 46 PRN visits 1196 minutes 20 hours April 26 minutes 28 PRN visits 728 minutes 12 hours

21 Bold Goals Value Proposition Summary NEISD Asthma Awareness Education Program Initial input cost of $63,000: Financial Impact: REDUCTION in annual average school days missed for 8,000 students with asthma: 1 day = $267,552; 50% = $1 Million Academic Impact: DECREASE in asthma related clinic visits REDUCTION in Loss of Academic Instruction Time Reduce barriers for Asthma students: achieve full academic potential Human Impact: IMPROVED Quality of Life, Change in Culture

22 Create an environment conducive to learning for all students Healthier children learn better and come to $chool Diane Rhodes BBA, RRT, AE-C, RCP North East Independent School District