The use of asthma action plans in improving asthma control: a quality improvement project

Abstract

Background: In the United States, approximately 1 in 13 adults and children suffer from the chronic condition asthma. Asthma is a disease in which the airways of the lungs become inflamed, narrowed, or blocked due to bronchoconstriction and increased secretions, reducing airflow and gas exchange. Without proper treatment, asthma exacerbations may lead to death in worst-case scenarios. An Asthma Action Plan (AAP) is a written, individualized template that lists actions patients can take to keep asthma symptoms from worsening. An AAP also provides guidelines that indicate when patients should call a provider or go to the emergency room. Methods: Current workflows, previously created when Asthma Control Tests (ACT) were implemented, were expanded upon to include implementation of AAPs. AAPs are created using the National Asthma Education and Prevention Program (NAEPP) guidelines. Implementation consisted of three two-week Plan-Do-Study-Act cycles with debriefing sessions after quantitative and qualitative data collection. Results: 70% of patients received AAPs in the final implementation phase compared to 25% in the first and 56% in the second implementation phases. The provider felt increased confidence in managing the patient's asthma through evidence-based guidelines. Nursing felt an increased strain on workload and moderate resistance from patients. Front desk staff noted minimal changes in daily work and believes patients appreciate receiving AAPs to take home. ACT rates were 85% in the first cycle, improving to 89% in the second and 100% in the final cycle. The provider and nursing believe the ACT is a useful tool for understanding patient asthma control. Conclusion: Implementing AAPs was monumental in the standardization of managing asthma in a small one-provider private practice clinic. Further research can now be completed to assess whether implementing AAPs actually improves patient asthma symptoms through ACT score evaluation. More work could be done on assessing the severity of asthma in patients and evaluating patient inhaler techniques.