Improving Provider Adherence with Completion of a Written Asthma Action Plan according to Evidence-Based Practice Guidelines
Abstract
**Please note that the full text is embargoed** ABSTRACT: Asthma is a serious chronic inflammatory health condition of the airways that causes
many Americans to experience distress {Agency for Health Care Research and Quality [AHRQ],
2009). Asthma prevalence over the age of 16 has become particularly concerning. It is a costly
disease that has increased drastically in recent decades (AHRQ, 2009). Many factors cause our
nation to collectively attempt to improve the quality of care for these individuals. The primary
goal is to treat the underlying inflammation and manage daily symptoms.
Regardless of national recommendations, health care providers experience challenges
with compliance. In one study, all primary care providers and specialists surveyed (N = 512)
were providing suboptimal asthma care related to national asthma guidelines (Rance,
O'Laughlen, & Ting, 2011). Many publications indicate that health care providers have a lack of
understanding regarding the National Heart, Lung, and Blood Institute's National Guidelines
(NHLBI) (Crim, 2000).
This small descriptive study was conducted over a 12-week period during the summer of
2014 in a suburban college health center in Arlington, Texas. An evidence-based educational
intervention based upon NHLBI guidelines was provided to all front office staff, registered
nurses (RNs), and providers. Additionally, a system procedural change (adding a blank asthma
action plan in out guides) was implemented. The out guide is a colored folder that is assigned to
each provider that provides patient's name and identification number. The out guide is patient
specific. A medical record review was completed for all eligible medical records for individuals
with a diagnosis of asthma that met inclusion criteria (N = 34). After the study period, provider
adherence and level of compliance with the completion of asthma action plans {AAPs) was
analyzed and measured. Thirty patients from the sample met the inclusion criteria for the chart review for the 12-
week study period. Level of compliance was determined to be high with 25 out of 34 records
with entirely completed AAP (73.5%). When comparing advanced practice registered nurses
(APRNs) compliance compared to medical doctors (MD), APRNs compliance was better for all
three areas measured.
Long-term health conditions require placing emphasis on self-care related to management
and treatment. Educating health care providers regarding the significance of an AAP according
to evidence-based practice will contribute to their comfort level and increase adherence. In a
study by Kaferle & Wimsatt (2012), greatest improvement was found with clinics that instituted
asthma education, clinical reminders, and registered nurse engagement.
Evidence-based practice is rapidly replacing the traditional health care decision prototype
previously experienced (Melnyk & Fineout-Overholt, 2011). The Doctorate of Nursing Practice
(DNP) role consists of synthesizing evidence and implementing best practices in the clinical
setting. The educational intervention and system procedural change in this quality improvement
project allowed the leadership role of the DNP to positively influence provider adherence with
the use of AAPs.