1. Safety and Quality Collaborative Asthma Implementation Kick-Off Meeting 10.16.13 1:00PM - 3:00PM

2. CHAT Safety and Quality Collaborative Roll call

3. CHAT Safety and Quality Collaborative Purpose Welcome visitors/colleagues of the champions

4. CHAT Safety and Quality Collaborative Objectives: To share all the deliverables developed by the various CHAT taskforces To launch the implementation of interventions

5. CHAT Safety and Quality Collaborative

6. CHAT Safety and Quality Collaborative Manual of Operations Benedetta Belli-McQueen, MS, MA, MPH Texas Children's Hospital

7. CHAT Asthma Quality and Safety Collaborative Comprehensive Site Workbook • Table Of Contents • Evidence Based Pathways An Related Appendices • The Implementation Package • Implementation Key Driver Diagram • Patient And Hospital-level Interventions • Asthma Best Practices Matrix • Asthma Multi-disciplinary Discharge Checklist • Education • Asthma Key Driver Diagram • Education Primer • Abbreviated Version • Full Version • Brief Presentation For The Unit Council • Pre And Post Assessment

8. CHAT Asthma Quality and Safety Collaborative Comprehensive Site Workbook • Table Of Contents Cont. • Metrics • Scorecard • Data Dictionary • Data Collection Forms • Culture • Stakeholders Matrix • Strategies For Engagement Of Stakeholders • The Four Conversation Matrix • Asthma–related Story - 90 Seconds Elevator Speech • Strategies To Influence People Behavior • Strategies To Celebrate Success • Talking Points

9. CHAT Safety and Quality Collaborative CHAT Pathway Development Taskforce Esther Sampayo, MD, MPH Texas Children's Hospital

10. Asthma Pathway Development Process • 5 teleconferences • Evidence • Emergency Medicine Algorithm • Inpatient Algorithm • Iterative process of pathway development • 6th version vetted to entire collaborative • 7th version created from feedback • 8th and final version was approved by pathway committee prior to submission to webpage developer

11. Asthma Pathway • Reflects continuum of care from initial ED evaluation through discharge from inpatient unit • ED pathway is based on first 3 hours of management and escalation/ de-escalation of therapy • Inpatient pathway is focused on weaning process and discharge management • Hyperlinks will address evidence, best practice, dosages, references

15. Risk Factors for Near Fatal Asthma • Previous severe exacerbation (e.g., intubation or ICU admission) • > 2hospitalizations or 3EC visits in the past year • Use of > 1 canister of Short Acting Beta Agonist (SABA) per month • Difficulty perceiving airway obstruction or the severity of worsening asthma (parent &/or child) • Low socioeconomic status or inner-city residence • Illicit drug use • Major psychosocial problems or psychiatric disease

16. ED Pathway • In children and adolescents with acute asthma exacerbation, no significant difference exists for important clinical responses such as time to recovery of asthma symptoms, repeat visits, or hospital admissions when medications are delivered via HFA with Valved Holding Chamber (VHC) or nebulizer.   • HFA with VHC is preferred. • Continuous Albuterol is as effective as intermittent but should be reserved for children requiring administration more than every 1 hour and for children with life threatening asthma.

17. ED Pathway

18. Hyperlinks

19. ED Pathway Strong recommendation with high quality evidence for the use of ipratropium bromide with beta agonist for up to three doses as adjunct therapy in children with moderate – severe asthma exacerbations

20. ED Pathway • Strong recommendation with moderate quality evidence for the use of IV magnesium sulfate as adjunct therapy when there is inadequate response to conventional therapy in children with severe asthma exacerbations. • Weak recommendation with low-quality evidence to use IV terbutaline in a monitored care setting for the treatment of children with severe asthma exacerbations. • Strong recommendation with low quality evidence for the use of non-invasive positive pressure ventilation prior to intubation in children with severe asthma exacerbations. 

21. ED Pathway

22. Inpatient Pathway

24. Inpatient Pathway

25. CHAT Safety and Quality Collaborative CHAT Implementation Taskforce Joyee Vachani, MD, M.Ed. Texas Children's Hospital

27. Intervention Bundle

28. Intervention Bundle Cont.

29. Asthma Best Practices Matrix

30. Asthma Best Practices Matrix Cont.

31. Asthma Best Practices Matrix Cont.

33. CHAT Safety and Quality Collaborative CHAT Education Taskforce Charles Macias, MD, MPH Texas Children's Hospital

35. CHAT Safety and Quality Collaborative • Education primer: • An abbreviated version • Brief education for the Unit Council • A full version, if a more specific explanation is desired

36. Pre and Post Assessments

37. Pre and Post Assessments Cont.

38. CHAT Safety and Quality Collaborative CHAT Metrics Taskforce Krystle Bartley, MA Texas Children's Hospital

39. Modified Delphi Process Meeting #3 Meeting #1 Meeting #2 Offline Meeting #4 • Meeting #1 Introduction & Build Framework • Literature Review for Asthma Measures • Meeting #2 Metrics Discussion • Meeting #3 Metrics Discussion Cont’d • 1st Round Ratings • Meeting #4 Common/Conflicting Viewpoints Identified • 2nd Round Ratings • Group Consensus • Rank Top 5-10 Measures • Balanced Scorecard Distributed for Final Vetting

40. Asthma Metrics Scorecard (ED) ǂ Goal will be re-evaluated after current baseline/site benchmark is collected * Indicates optional measure

41. Asthma Metrics Scorecard (IP) ǂ Goal will be re-evaluated after current baseline/site benchmark is collected

42. CHAT Safety and Quality Collaborative CHAT Data Management Taskforce Dana Danaher, RN, CPHQ Dell Children’s Medical Center

43. Measures (ED)

44. Measures (ED) Cont.

45. Measures (ED) Cont.

46. Measures (IP)

47. Measures (IP) Cont.

48. Measures (IP) Cont.

49. Data Collection Form

50. Data Collection Form Cont. IP ED