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Vermont Department of Health - Maternal & Child Health (Asthma)

OLH SHIP-related activities

Individual

% of students with asthma  that have a current (<1 year old) VT Asthma Action Plan or equivalent

51%2018

Story Behind the Curve

Last Update: April 2015

Author: Division of Maternal and Child Health, Vermont Department of Health

This is a new performance measure for the Division of Maternal and Child Health (MCH) at the Vermont Department of Health (VDH) though promotion of the use of the Vermont Asthma Action Plan by students and schools has been an activity of the Health Department School Liaisons (12 public health nurses and a nutritionist located in each of the Office of Local Health (OLH) district offices that work closely with schools) for some time now.


Vermont School Nurses in public schools are asked each year to report the number of students with a diagnosis of asthma, and the number of students with a Vermont Asthma Action Plan (or equivalent), on the Vermont School Nurse Report.This data is often collected by school nurses using annual student health update forms.These forms are completed by the student’s parent or caregiver.Of those students that have a parent/caregiver-reported diagnosis of asthma, school nurses report the number of students who have a complete and current asthma action plan (or equivalent) on file at the school. Having this on file indicates a positive link between the medical home and the family.

The percentages of students with asthma that have a current asthma action plan have increased gradually over time.School Liaisons continue to work with School Nurses and provider offices to increase their understanding of the importance of having an asthma action plan on file at the school, and decrease barriers to their completion, and ultimately, their arrival in the school health services office.It is important to note that the School Nurse Report captures information at a single point in time.The report is due January, 1st, but may be completed prior to this date.If a school chooses to enter their information earlier in the school year, the data may not capture their ongoing effort to pursue delinquent plans throughout the school year.

Partners

The Vermont Department of Health, Divisions of Maternal and Child Health and Health Promotion and Disease Prevention, and the Office of Local Health (specifically the VDH School Liaisons located in each of the 12 district offices) , the Agency of Education, the Vermont Chapters of the American Academy of Pediatrics and the Vermont Academy of Family Physicians, Vermont schools, supervisory unions, and school districts.

What Works

People with asthma should routinely check-in with their medical home to assess the current status of their asthma, and ensure their plan for managing their diagnosis is working well.These visits can help the child and caregivers identify triggers in the environment which could be addressed or avoided, to recognize symptoms of an exacerbation or severe reaction, and know when and how to use medications and seek medical attention.One way to ensure proper management of asthma is to have an asthma action plan.Asthma action plans are demonstrated to improve health outcomes by providing a consistent reminder of how to monitor and treat an individual with asthma. The Vermont Asthma Action Plan is a form that serves as a written asthma management plan in a simple and user-friendly format, and acts as a communication tool for those sharing in the individual’s asthma management. The plans include information such as, what medicines to take to stay healthy, a list of asthma triggers to avoid, how to recognize and treat asthma episodes, and when to seek help.

In the school setting, these tools are used by school nurses to communicate to school personnel how to help the student manage their asthma, and to provide instructions about what to do in an emergency (including in the school, during sports practice or events, and on field trips).Since the vast majority of Vermont’s school-aged children are in public schools, school nurses are important partners in our asthma related work.They work closely with students and families to develop strong connections with the student’s medical home to ensure consistent and effective management of a student’s asthma.Proper management of an asthma diagnosis helps to decrease asthma related absenteeism, and keep students in, or return them to, the classroom as soon as possible.

Action Plan

Ongoing promotion of the use of the Vermont Asthma Action Plan continues to be part of Health Department School Liaison’s work.The School Liaisons are available to provide guidance and assist school nurses with improving communications with local provider offices.This can help to improve the rate of asthma action plan receipt at the school setting.

The School Liaisons and the VT State School Nurse Consultant continue to work with School Nurses to track students with special health needs such as diabetes, life-threatening allergies, seizure disorders, and asthma (and many more).This tracking includes using school health records (including electronic health records) to track students with special health needs, ensure they have obtained or created a current student individualized health care plans and/or emergency care plans, and that all relevant staff have had appropriate training needed to assist in the student’s care.School nurses maintain documentation of care provided tor students with all chronic illnesses, student education in disease management and self-care skills, all referrals, and communications with the families and the students’ medical homes.Accurate documentation helps the student and team track changes in wellness and disease status, and the need for specified nursing and health interventions.Guidance related to documentation, medication management, and working with children with special health needs is available in the Standards of Practice:School Health Services Manual.

The Division of Maternal and Child Health (MCH) continues to coordinate with the Asthma Program in the Division of Health Promotion and Disease Prevention (HPDP) on several asthma-related efforts.During the 2013/2014 school year, school nurse received a memo from the Asthma Program requesting that they consider including a standardized set of questions on the school’s annual student emergency or health update form. Though all public schools have been reporting on the number of student’s with asthma and asthma action plans, the manner in which this information is asked may vary from school to school.The following questions were provided to the school nurses, and reflect validated questions provided by the Centers for Disease Control and Prevention which align with questions used for the Behavioral Risk Factor Surveillance System.

The questions are:

  • Has a doctor, nurse or other health professional EVER said that your child has asthma?
  • If yes, does your child STILL have asthma?

Response Categories: “yes”, “no”, “don’t know/not sure”, and did not answer the question

Response Categories: “yes”, “no”, “don’t know/not sure” and did not answer the question

The 2014/2015 Vermont School Nurse Report was edited to accommodate data entry for schools that implemented the new question format this year.

The MCH is also working with HPDP on the development and implementation of a school-based electronic health record (EHR) asthma grant, based on work being done over the last four years promoting the purchase of student electronic health records (EHR) with a grant that involves flu-like and acute gastrointestinal illness surveillance. The use of EHRs is an important resource for identifying, tracking, and maintaining current individual health plan (IHP) for students with asthma. Our partner, the Vermont Asthma Program is assessing what school nurses who use student EHRs may need for additional training related to asthma care, management, and guidance on how to create linkages of care between medical homes, schools, and families of students with asthma. Currently 25 participating school nurses have the opportunity to collect baseline data that will drive the development of new asthma management tools. These nurses represent the Springfield School District, the Barre School District and the Chittenden East Supervisory Union. The tools will further guide asthma care, improve school health services, and ultimately outcomes for their students. This asthma grant allows them to demonstrate leadership for other school nurses as they model their acquired knowledge and skills. The VDH State School Nurse Consultant coordinates with the Asthma Program on this grant work, promotes the exchange of educational information through the AOE newsletters, the VDH School Nurse (SN) Bulletin, as well as connects with participating school nurses and Health Department School Liaisons.

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