Asthma Action Plan use

Yolanda: How were you able to improve use of AAPs in school from 18% to 65%?

Training was provided to over 500 School Nurses in the use of an AAP and at each home visit or interaction with the parent and student we provide an AAP and review the form with the parent.

Teresa can probably add to this, but I'll start the discussion.

Law certainly helped - they needed an AAP to carry their inhalers.

Using one form statewide - eventually getting an electronically fillable form.

PACNJ surveyed the nurses about reasons they didn't get AAP's back and worked out solutions for those barriers.  Since state can't mandate forms, they can only recommend, PACNJ got the Dept of Ed and DOH to say that the AAP qualified as nurses orders for asthma to eliminate another needed form and local resistance. This is the only form with that approval. Made sure doctors signature was correct.  Worked with insurers to clarify rules about docs not charging extra for forms.

Made it a requirement for the award that most students have one.

Developed a parent piece to tell parents why it was important.  

One of the training pieces is specifically for nurses on why the AAP is important and they really did carry the ball on pestering folks to get them back to the office.

Just wondering if you can clarify what is meant by having "nurses orders for asthma"  I don't believe this is a part of our Nurse Practice Act.  Would appreciate any information.

My interpretation is that the AAP qualified as MD orders to the nurse.  In looking at other successful programs in other areas, this double use of the form (communication between all parties, PLUS official MD orders) yielded much higher acceptance and use.

That being said, we are having local problems using parents as go between to get MD to fill out AAP.  Some of our target population do not have a primary care provider to fill it out, and making an appointment just to do paperwork is not a priority.

Any thoughts on how to overcome this?

Sorry - physicians' orders.  It's covered in the Nurses AAP training, which is online

My only thought to overcome the barrier of populations not making it a priority to make a doctors appointment to get paperwork filled out is to work to develop a Telemedicine Partnership with Schools. This may require policy change what is currently accepted for billing, but that should not be a barrier. Start with a pilot between one school district and Medicaid/CHIP insurance providers, and if successful, then work on your commercial insurance providers.