Increasing Asthma Medication Administration Forms in Three Elementary Schools: A Quality Improvement Project

AIM statement School-aged children in the Bronx have twice the rate of asthma-related hospitalizations than children in New York City and rank first in elementary school absenteeism. Asthma is one of the leading causes of school absenteeism in NYC. Insuring that asthmatic children adhere to their medication regimen and receive timely treatment for exacerbations at school is critical for asthma control and school performance. Children need an Asthma Medication Administration Form (AMAF) in school in order to receive treatment by the school nurse. Without this form, treatment cannot be given and symptomatic children must be sent home or to the ED for treatment. A recent study demonstrated that only 27% of children have AMAF in school files. The AIM of this quality improvement project was to increase the percentage of asthmatic children receiving care in our Federally Qualified Health Center with an AMAF in three target elementary schools to 90% by the end of the first quarter of School Year 2017-18. Process for Improvement To identify barriers for getting AMAF to schools the QI team utilized Fishbone and Key Driver diagrams as well as a Process Map Toolkit. PDSA cycles were conducted beginning in School Year 2016/2017 and refined in School Year 2017/2018. Results A Run Chart was set up to monitor data and by December 2017, three months after the start of school, 90% (N=51) had a completed AMAF in school compared to 46% (N=51) in December 2016. Factors that affected success Barriers identified included health center factors such as no EMR prompts for providers to complete annual AMAF and parental factor such as low rates of parents picking up completed AMAF from the health center and remembering to bring signed forms to school. These barriers were addressed through QI activities utilizing health center data systems to identify children at target schools, chart reviews to confirm if AMAFs were completed by the pediatric provider, and reminder calls to parents asking them to take the forms to school. Additionally, Improvements were made in getting parents to sign release of information consent forms, allowing the health center to directly fax AMAF to school, reducing parental burden. A system was also created to improve communication between health center staff and school nurses to monitor whether forms had arrived in school. This QI project led to the doubling of AMAF in schools from school year 2016/17 to 2017/2018. Next steps AMAF need to be in school as ear