IMPROVING ASTHMA DOCUMENTATION IN A PEDIATRIC EMERGENCY DEPARTMENT

Objective: To improve documentation for children presenting to the Eme rgency Department (ED) of The Children's Hospital with acute asthma. M ethodology: In phase I, the documentation process was analysed using a standard total quality management (TQM) approach to identify specific problems leading to poor documentation. Fifty-two medical records of children presenting over a 3 week period were reviewed for nursing and medical documentation. A set of minimum criteria, consistent with the Paediatric Asthma Management Plan, were established for documentation by both medical and nursing staff. Following dissemination and educat ion, compliance with documentation was evaluated and compared to an as thma survey performed in the ED in 1991. In phase II, a specific profo rma for medical assessment was developed and 80 medical records of chi ldren presenting over a 3 week period were reviewed. Fifty-two (65%) w ith completed proformas were evaluated. The outcome measure was the do cumentation rate for minimum criteria established by TBM process. Resu lts: In phase I, nursing compliance with documentation ranged from 46% for signs of respiratory distress to 83% for a past history of asthma and 100% for pulse rate. Doctors were similarly poor at documenting e ssential elements such as severity (31%), palpable pulsus paradoxus (2 9%), the child's usual doctor (46%) and follow-up arrangements (21-56% ). In phase II, the documentation of the severity of acute asthma (42% ) and of the child's usual doctor (42%) remained poor but there were s tatistically significant improvements in documentation of interval med ications, palpable pulsus paradoxus, respiratory rate, pre-treatment o ximetry, education, follow-up arrangements and communication letters. Conclusion: The process of TQM has proved valuable in improving some a spects of documentation of children presenting to ED with acute asthma . It remains to be shown whether improved documentation will result in improved outcome.