Trillium Health Centre Closes the Gaps in Asthma Management

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For asthma sufferers, taking a breath can sometimes be difficult. It shouldn’t be. Through its proactive approach to asthma management, Trillium Health Centre’s Asthma Education Centre (AEC) helps patients with asthma achieve an improved quality of life. By helping patients identify personal triggers and establishing personal action plans for recognizing early warning signs, improving medications, and developing individualized monitoring techniques, patients’ asthmatic symptoms are minimized.But what about all those asthma sufferers never taught how to identify personal triggers or to develop a personal action plan? What happens to all those that are never seen in an asthma education centre?

According to a study titled ‘Asthma in Canada: a landmark survey’, asthma is a leading cause of hospital admissions, and emergency and urgent care visits. The study, conducted by The Angus Reid Group and funded by Glaxo Wellcome Inc., found people with asthma are leading a much lower quality of life due to poor asthma management techniques. However, most people with asthma (91 per cent) believe they have good control of their asthma when in fact only 34 per cent actually do. The result is a vicious cycle of recurring attacks of breathlessness accompanied by wheezing, chest tightness and coughing leading to physician and hospital visits, and absenteeism from work and school.

The study also indicates there is a huge gap in perception among physicians in what constitutes good control of asthma. These health-care providers often report not feeling well equipped to treat patients with asthma.

With more than two million Canadians living with asthma, nearly 30 per cent of them children, Trillium recognized the need to improve health care for asthma sufferers within the hospital setting as well as in the community at large. To accomplish this, Trillium realized physicians, nurses and other health-care providers would have to be educated on the importance and methods of good control so that they in turn could promote control of asthma in their day-to-day practice. As a result, the Health Centre partnered with GlaxoSmithKline and developed the teaching tool ‘my personal Asthma Control Plan’. When the RNAO put out a call for proposals for implementation of Adult Asthma Best Practice Guidelines for Nursing: promoting control of Asthma, Trillium submitted a proposal and was delighted to be selected as the pilot site for Ontario.

Teaching Tool: ‘My Personal Asthma Control Plan”My personal Asthma Control Plan’ is designed for physicians, nurses, and other health care providers to use in educating patients about asthma and asthma management throughout the community as well as in hospital. It is also a resource for patients on asthma and proper asthma management. The tool kit includes space for patients’ individualized action plans as well as key components of their condition and treatment making the kit a good record of a person’s asthma history.

To date, the feedback received from physicians and nurses using ‘my personal Asthma Control Plan’ has been tremendous. Physicians are finding it a comprehensive and easy to use tool in educating patients. Having had the opportunity to test the kit and provide recommendations, these physicians are now educating and promoting the kit to their peers in the community. The kit also enhances the teaching that our nurses are currently carrying out within the Adult Asthma Best Practice Project.

Adult Asthma Best Practice Project The Adult Asthma Best Practice Guidelines for Nursing: promoting control of Asthma project focuses on assisting nurses in identifying patients with asthma and supports asthma education. Self-managed action plans, proper use of inhalers/devices, medications, and referrals/resources are also important elements. Under the leadership of Sandy Haist and Kathie Harcourt, RNs and Project Leaders for the Asthma Best Practice project, Trillium nurses play a key role in promoting control of asthma to their patients through assessment, education, and referral.

During the ten-month pilot stage, scheduled for completion in November 2002, the project is focusing on Trillium’s Emergency Care Centre, Urgent Care Centre, Clinical Decision Unit and medical inpatient units as they are the areas that see the most asthma patients. A huge part of this project is nursing education and to date, 195 nurses have been trained in asthma management.

Preliminary and post data collection of patients and staff are also a part of the project. Patient surveys and interviews, chart audits as well as nursing interviews provided a benchmark for measuring the success of the project. The anticipated outcomes of the project include:

  • Consistency in patient assessment and education across Trillium
  • Establishing an action plan for every patient
  • Appropriate referrals for patients
  • Improved quality of life for patients
  • Consistent, minimum base knowledge for all nurses caring for patients with asthma
  • Use of teaching tools to promote understanding of asthma management.

Trillium’s ultimate objective is to improve asthma care in Ontario. Starting in the Fall, the asthma kit will be distributed to Family Practice Nurses and education will be provided on how to use it. Once the Best Practice Project is complete, it will be evaluated. The final implementation guidelines will then be applied to all hospital areas and into Trillium’s community. It is our hope that the learning acquired at Trillium will have a positive impact on the care provided to asthma patients throughout Ontario.