Improving Provider Adherence to Asthma Management Guidelines Through the Use of a Reminder Tool: A Doctor of Nursing Practice Project

Asthma is a reversible airway disease of the lungs and the leading chronic disease in children. The National Asthma Education and Prevention Program (NAEPP) published the Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma (EPR-3) in 2007, which recommends that patients be provided with a written asthma action plan (AAP) in order to manage symptoms and recognize exacerbations. Evidence supports the use of written AAPs to reduce hospitalizations and emergency department visits, decrease symptoms, and improve quality of life. Despite this knowledge, providers do not regularly provide their patients with AAPs for a multitude of reasons. Guided by the Iowa Model, the purpose of this project was to implement an evidence-based electronic reminder tool to improve provider adherence to national asthma guidelines and increase the percentage of patients with a documented AAP. This project utilized an electronic medical record template for asthma patients who presented for well-child checks or asthma follow-up visits in the outpatient setting. Pediatric patients with a documented asthma diagnosis in their problem list were flagged for inclusion. Nurses and providers were responsible for completing the template at each visit and providing the patient with an updated AAP. Manual chart audits were conducted and outcome variables were analyzed in order to determine if the reminder tool increased the percentage of asthma patients with a documented AAP. Prior to implementation 9.2% of asthmatic patients within the clinic had a documented AAP, which increased to 12% at the conclusion of the pilot. Twenty out of 31 visits (64.5%) that met the inclusion criteria and occurred during the implementation period contained the provision of an AAP.