Friday, January 4, 2019

Example of a process for improving quality measures


Welcome back and Happy New Year 1/4/19


During my continued effort to complete my project, and getting distracted every other minute.  The completed project is due January 22nd.  I found the slide show below put together by HealthInsight.

I feel it provides great information explaining electronic clinical quality improvement (eCQI).  Which I knew everyone wanted to learn more about. RIGHT?!?!?  Even if you don't want to learn more it may provide you with a clear picture of why I love process improvement and how it can be done.

It also provides links to helpful resources and Meaningful Use blogs.




Improving Your Score with eCQI. Quality Improvement Organizations

Tuesday, December 18, 2018

Pretest & Posttest with Answers

PRETEST
1 What does asthma look like?
  Inflamed airways
  Breathing tubes surrounded by tightened muscles
  Mucus filled tubes
  all of the above
2 If a patient calls with complaints of difficulty breathing, and chest pain they should be instructed to use their fast-acting bronchodilator.
  True--control medications should be used daily
  False
3 Peak flow meter rates should be checked weekly
  True
  False-they should be checked daily.
4 Peak flow meter rate should be recorded on all Asthma Action Plans.
  True--peak flow rates should be recorded for the patient to know where his or her Go, Caution, and Danger zones are.
  False
5 Which of the following should be charted after a nurse visit for asthma education?
  Nurse visit
  Patient education
  Shortness of breath and/or coughing (if present)
  Asthma diagnoses codes assigned by medical provider
  All of the above--all symtoms the patient has should be documented.  A nurse visit should be selected in the wrap-up.  If asthma education is being provided the asthma diagnoses the patient has assigned should be selected to go with the education.
6 My role in clinic is.  (This is the person who is taking the test)
  Nurse  
  Medical Assistant
  Medical Provider
  Other not listed here
7 Asthma education should always be documented in the patient's chart.
  True
  False
8 Asthma symptoms include which of the following?
  Difficulty breathing
  Night cough
  Chest tightness
  Wheezing
  Dry cough
9 When taking a does of your inhaler you should try to hold it in for 
  5 seconds
  10 seconds
  20 seconds
  It doesn't matter how long I hold it in
10 Only children need spacers for their inhaler.
 
True
  False-a spacer can be helpful for all people using an inhaler

POSTTEST
1 What does asthma look like?
  Inflamed airways
  Breathing tubes surrounded by tightened muscles
  Mucus filled tubes
  all of the above
2 If a patient is not having asthma symptoms they do not need to use their asthma control medication
  True
  False--control medication should be used daily
3 Peak flow meter rates should be checked weekly
  True
  False-they should be checked daily.
4 Peak flow meter rate should be recorded on all Asthma Action Plans.
  True--peak flow rates should be recorded for the patient to know where his or her Go, Caution, and Danger zones are.
  False
5 Which of the following should be charted after a nurse visit for asthma education?
  Nurse visit
  Patient education
  Shortness of breath and/or coughing (if present)
  Asthma diagnoses codes assigned by medical provider
  All of the above--all symptoms the patient has should be documented.  A nurse visit should be selected in the wrap-up.  If asthma education is being provided the asthma diagnoses the patient has assigned should be selected to go with the education.
6 My role in clinic is.  (This is the person who is taking the test)
  Nurse  
  Medical Assistant
  Medical Provider
  Other not listed here
7 Asthma education should always be documented in the patient's chart.
  True
  False
8 I learned something from this blog?
  Yes
  No
9 What was helpful about this blog?
  Comment
10 What could be added to this blog to help you in the clinical setting?
  Comment

Wednesday, December 5, 2018

Asthma Education

Thanks for visiting my blog.  I created it as a place to collect the great asthma information I was collecting for a school project.  

The project started with me trying to create a workflow for improving asthma clinical quality measures (CQMs).  My professor said that it was too big of a project to take on in 7 weeks.  My preceptor recommended peak flow meter patient education.  While focusing on peak flow meter patient education, I was learning how little I knew about asthma and how much asthma education I needed to have before I could educate patients.  During my asthma research, I found the information in this blog.

This is my first blog, so it is not aesthetically pleasing, but it has great information that I hope is helpful and informative to you.  I also add/edit information as I educate myself and receive feedback about my information.  So please comment if you have suggestions or comments.  

There are links to take a pretest and a posttest.  The answers will not be provided for you after taking the test.  You may see the answers on my blog.  Look at December 18, 18 Pretest & Posttest with answers.

Thanks!  Mikey, BSN, RN


Link to Pretest




What Asthma Looks Like





Air Tubes in the Lungs
Swell 
Constrict
Make Extra Mucus

Asthma Symptoms

Difficulty Breathing
Dry Cough
Chest Pain or Tightness
Wheezing 
Night Cough


Link to video below, Confirming the Diagnosis of Asthma








Take the Asthma Control Test (ACT)
The ACT is one of the reference tests used for CQM #398: Optimal Asthma Control.  Asthma well-controlled based on the ACT, C-ACT, or ATAQ score.
C-ACT is the Childhood Asthma Control Test
ATAQ is the Asthma Therapy Assessment Questionnaire



Asthma Education for Kids
Iggy & the Inhalers provide asthma education tools for kids in English and Spanish.
The site provides clinic resources, free downloads, videos, and a store to buy educational materials for patients.

below is a sample of what the site offers




Asthma Treatments

Rescue Medications

Albuterol (AccuNeb, Proair HFA, Proventil HFA, Ventolin HFA)
Metaproternol
Levalbuterol (Xopenex HFA)
Pirbuterol (Maxair)


Used when asthma symptoms occur

Coughing
Wheezing 
Difficulty Breathing


(Seattle Children's, 2015) link Seattle Children's pdf

Control Medications
Fluticasone (Flovent HFA)
Budesonide (Pulmicort Flexhaler)
Mometasone (Asmanex Twisthaler)
Beclomethasone (Qvar RediHaler)
Ciclesonide (Alvesco)

Asthma c
ontrol medications are used daily 

to prevent the occurrence of asthma symptoms.

Patients with a diagnosis of persistent asthma, see diagnosis codes under Quality Measure Documentation, should have a prescription ordered for an asthma controller medication for each month that they have an active diagnosis of persistent asthma to meet the quality measure.


(Seattle Children's, 2015)  link to Seattle Children's pdf



This video is over 10 minutes long with lots of great information.

This video is in Spanish with English subtitles



How to use an Inhaler
  1. Shake inhaler
  2. Take cap off
  3. Breath all air out of lungs
  4. Place lips tightly around mouthpiece
  5. Slowly breath in while administering 1 dose of inhaler
  6. Slowly count to 10 while holding your breath
  7. Breath medication out after counting to 10
  8. If you are prescribed a 2nd dose
  9. Wait 1 minute
  10. Repeat steps above
  11. Clean mouthpiece & replace cap



This video talks about the inhaler.  
If you want to see only the demonstration you can start the video around 3:30.




Please refer to the following links for proper inhaler use with a spacer.  
Spacers can be used by patients of all ages.






Proventil HFA Information Video




Asthma Risk Factors

Family History
Viral Respiratory Infection
Allergies
Occupational Exposures
Smoking
Air Pollution
Obesity


Peak Flow Meter use with Asthma
  1. Move marker to base
  2. Stand up
  3. Take a deep breath in
  4. Close lips tightly around mouthpiece
  5. Blow air out of lungs hard & fast
  6. (this should be 1 single blow)
  7. Score will be number marker stops at
  8. Repeat steps 3 times
  9. The highest number recorded is the number you record for the day



Link to below video, American Lung Association-Measuring Your Peak Flow Rate.




There are many types of peak flow meters.  The video above demonstrates one example.  
Below is a photo of another peak flow meter.



Example of a daily Asthma Diary
Peak Flow Readings should be charted daily



(Seattle Children's Hospital, 2015, p. 30) link to Seattle Children's pdf


Links to Visit for more Peak Flow Meter information









Asthma Triggers
Dust Mites
Pet Dander
Smoke
Colds
Exercise
Pollen 







(Seattle Children's Hospital, 2015, p. 32)


Asthma Action Plan
The below video explains what and Asthma Action Plan is and why it is important to patients with asthma.




Below is an example of an electronic action plan.  The arrow is pointing to the section where the peak flow meter score is entered.  





The example below shows a completed Asthma Action Plan in EPIC and how to print it.




Below is an example of a paper Asthma Action Plan


(Seattle Children's Hospital, 2015, p. 3)

The below video explains why the school nurse needs an updated Asthma Action Plan 




Charting Asthma Information after a 
Nurse Visit in EPIC

Visit diagnosis
Z71.89 Encounter for education, Health education/counseling
Z55.9 Lack of education
Z63.8 Needs parenting support and education
Z78.9 No barriers to education
R06.2 Wheezing
R05 Cough
R06.02 Short of breath

Wrap-Up
Charge Capture
94060 PR EVAL OF BRONCHOSPASM
94015 PR PT RECORDED SPIROMETRY (Spirometry recording, education)
98960 PR SELF-MGMT EDUC & TRAIN, 1 PT, EA 30 MIN (Education & Training face-to-face)
94664 PR DEMO &/OR EVAL, PT USE, AEROSOL DEVICE (Demonstration/evaluation inhaler)
99420R PR HEALTH RISK ASSESSMENT TEST (Test for asthma control)
A4614 PR HAND-HELD PEFR METER (Peak flow meter, handheld)
94640 PR PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT (Nebulizer treatments)
94760 PR NONINVASV OXYGEN SATUR; SINGLE (Oxygen saturation)
A4615 Nasal Cannula
A4616 Oxygen Tubing
A4617 Mouthpiece


Quality Measure Documentation


Patients who are included in the asthma quality measures
(link to document below)




Quality ID #398: Optimal Asthma Control - 
National Quality Strategy Domain: Effective Clinical Care

Measure Met if 

G9432 Code is charted - Asthma well-controlled based on the ACT, C-ACT, ACQ, or ATAQ score and documented

or

G9434 Code is charted
- Asthma not well-controlled based on the ACT, C-ACT, ACQ, or ATAQ score and documented

and

G9521 Code is charted - Patient is not at risk for exacerbation and less than two asthma related hospital visits in 12 months



Quality ID #444 (NQF 1799): Medication Management for People with Asthma - National Quality Strategy Domain: Efficiency and Cost Reduction


Measure only Met if 

G9810 Code is charted - Patient achieved a portion of days of at least 75% for their asthma controller medication during the measurement year.  (patient was prescribed a controller medication during their treatment period)





References

Seattle Children's Hospital. (2015). Living with asthma. Retrieved from Seattle Children's Hospital Research Foundation: https://www.seattlechildrens.org/globalassets/documents/for-patients-and-families/pfe/pe127.pdf
 Link to 



Thanks for visiting my blog.  Remember to comment with ideas to help me improve this blog.  I am still working on technical and 
aesthetics of creating a blog.  

Link to Posttest



Example of a process for improving quality measures

Welcome back and Happy New Year 1/4/19 During my continued effort to complete my project, and getting distracted every other minute. ...