1. Emergency Department Asthma Care Pathway (EDACP)
Pedriatric Asthma Quality Based Procedures (QBP)
Carole Madeley, RRT, CRE, MAppSc(RespSc)
Director, Respiratory Health Programs
Jennifer MacKinnon, BSc, RRT, CRE
Curriculum Developer, Provider Education Program

2. Objectives
The objectives of this presentation are to:
Inform respiratory therapists working in ED departments on the EDACP and the best practice evidence
Provide practical resources and tools for implementation and use of the EDACP
Provide an update on the Pediatric Asthma QBP

3. Ontario Asthma Program
Emergency Department Asthma Care Pathway
Smoke-Free Homes and Asthma
Work-related Asthma:
Provider Education
Farm Safety
Workplaces
Primary Care Provider Education
Health Promotion / Prevention
Asthma Client / Family
and Others
Asthma and Work-related Asthma Surveillance
School Initiatives
School-Based Approaches to Address Asthma
Public Health School Asthma Program
Indoor Air Quality School Guidelines
Asthma Action
Helpline
Children / Youth Public Education
Patient and Family Education
Primary Care Asthma Program
Management / Treatment
Research / Surveillance

4. Adult EDACP
Discrepancies between evidence-based guidelines and current practice
Sub-optimal use of objective measures (spirometry, peak flows)
Underutilization of systemic steroids both in the ED and on discharge
Low referral rates to specialized asthma services
Implemented in 2008 to address gaps in ED management

5. Adult EDACP Use of clinical pathways may improve quality of care by:
Promoting adherence to clinical guidelines
Reducing variation in treatment
Improving communication with patients and between members of the health care team
Allen D, et.al, Systematic review of the effectiveness of integrated care pathways: what works,
for whom, in which circumstances? Int J Evid Based Healthc. 2009;7(2):61-74

6. Adult EDACP Implementation

7. Adult EDACP Key Components
Accurate assessment of severity:
CTAS triage, Hx, frequent vitals & SaO2, spirometry or PEFR
Appropriate treatment:
Timely β2-agonist, systemic steroid in all but mildest cases
Appropriate discharge prescriptions:
β2-agonist, inhaled and/or oral steroid
Appropriate education prior to discharge:
Teaching checklist
Comprehensive discharge instructions
Follow-up care arranged and discussed

8. Pediatric EDACP
In 2014 The Lung Association – Ontario published the Pediatric Emergency Asthma Care Pathway (P-EDACP)
Supports best practice and key objectives of asthma management to improve asthma care delivery and patient outcomes in the ED
Potential for cost savings by:
Reducing the number of ED revisits by ensuring appropriate treatment in the ED as well as appropriate education and referral/follow-up instructions upon discharge
Reducing the number of inpatient admissions by ensuring appropriate treatment in the ED
Ensuring appropriate use of medications during both the ED and inpatient episodes of care

9. Pediatric EDACP Key Components
The P-EDACP includes a comprehensive algorithm that guides specific treatment at each severity level, the escalation of treatment if the patient’s condition worsens and when to consider discharge. It contains a number of tools including:
Triage severity assessment (PRAM)
Optional medical directive
Pre-printed order sets for each severity level
Patient education checklist
Discharge instructions and integrated prescription

10. Pediatric EDACP Clinical Pathways

11. Pediatric Respiratory Assessment Measure (PRAM)
Validated tool used to assess the severity of an asthma exacerbation
Provides instruction (as per the P- EDACP) based on the severity level
App has been downloaded 1644 times since launching in 2015
PRAM e-learning module:
Compatible with tablets, Chrome, Firefox, Internet Explorer 11
An excellent training resource for hospital staff

12. PRAM

13. PRAM App Screen Shot

14. EDACP Discharge Instructions (Pediatric)

15. Quality Based Procedures (QBP)
Provided by the MOHLTC and are based on the following principles:
Care is organized around the person to support their health
Quality and its continuous improvement is a critical goal across the health system
Quality of care is supported by the best evidence and standards of care
Payment, policy, and planning support quality and efficient use of resources
Excellent Care for all Act, 2010

16. Pediatric Asthma QBP Released March 2016
Recommends the use of The Lung Association - Ontario P-EDACP, developed by an Expert Content Working Group that included:
Paediatricians, paediatric emergentologists, respirologists
Respiratory therapists
Nurses
Pharmacists
Researchers
Could potentially be implemented by:
ED physicians
Asthma educators
Asthma specialist physicians (respirologists, allergists, pediatricians)

17. Pediatric Asthma QBP – Key Objectives
Provide clinicians with evidence-based recommendations regarding management of pediatric asthma for the emergency department and inpatient episodes of care and for discharge
Reduce variation in the diagnosis of asthma
Promote standardized assessment of severity
Promote standardized severity-based treatment
Reduce variation in the inpatient treatment of asthma
Reduce inappropriate ED revisits and inpatient admissions
Ensure that children discharged from the ED or inpatient units (and their parents) receive education regarding the management of their asthma and instructions for appropriate follow-up and referral via an Asthma Action Plan

18. Pediatric Asthma QBP
Successful implementation of the Paediatric Asthma QBP will:
Ensure more efficient and evidence-based management asthma in paediatric population
Reduce repeat ED visits and hospital admissions and potentially decrease ED LOS
Improve asthma self-management and symptom control
Increase capacity for care closer to home in community settings

19. Key Messages
With use of the associated medical directive in the P-EDACP, health professionals (nurses, RTs, pharmacists) can administer treatments in a timely manner, without waiting for a physician assessment and orders
Use of preprinted order sets also reduce errors and provide the team with a consistent, standardized treatment plan
The EDACP is available at no cost to Ontario health- care professionals and facilities for non-commercial use
The pathway tools can be accessed electronically through The Lung Association - Ontario website:
Hospitals are permitted to adapt the formatting of EDACP tools to suit their site’s requirements for order sets, including adding logos

20. EDACP e-Learning Modules A-EDACP: http://machealth.ca/programs/edacp/
Resources
EDACP e-Learning Modules
A-EDACP:
P-EDACP: emergency-department-asthma-care-pathway/
PRAM app available at: pediatric- sthma/id ?mt=8            
For android:
For information on how to access the P-EDACP contact:
Link to Pediatric Asthma QBP: d_asthma.pdf

21. Thank You