Nursing Best Practice Guideline

Adult Asthma Care Guidelines for Nurses: Promoting Control of Asthma

Evaluation Tools

Evaluation Tools
Patient Data Collection Instruments – Asthma Control in Adults
A pre and post evaluation was conducted of a five-month pilot implementation of a new
guideline on Asthma Control in Adults. The evaluation included a chart audit and in-hospital
interview and a telephone follow-up interview in the patient’s home. During the in-hospital
interview the patient was requested to demonstrate their use of an inhaler/delivery device.
The sample included adult patients who presented themselves to Emergency/Urgent Care,
a Clinical Decision Unit or a Medical Unit with a primary or secondary diagnosis of asthma.
Patients in acute or unstable conditions were not included until stabilized.
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Based on the data collected during the pilot, we would like to note difficulties encountered
in collecting the data. In emergency and urgent care departments, patient turnover was very
quick. Unless a data collector is there 24 hours a day, many patients are discharged before an
interviewed can be obtained. Nurses were able to obtain a signed consent form for some of
the patients and a data collector then telephoned the patient the next day for an interview.
In these cases, the demonstration component of the interview could not be done. We did not
find very many non-acute, stable patients admitted to the hospital. In many cases, as soon
as the patient was stable, they were discharged.

Barbara Davies, RN, PhD

Co-Principal Investigator
Ottawa, ON

Please note: These client data collection tools were developed for the evaluation of the
implementation draft of the RNAO Best Practice Guideline Adult Asthma Guidelines for
Nurses: Promoting Control of Asthma. Acknowledgement of the use or adaptation of these
tools is requested. The recommended citation is:

Edwards, N., Davies, B., Dobbins, M., Griffin, P., Ploeg, J., Skelly, J. (2003). RNAO Evaluation Team – Nursing Best
Practice Guidelines Project, Cycle 3.
 Nursing Best Practice Guideline
Adult Asthma Care Guidelines for Nurses: Promoting Control of Asthma
Evaluation Tools

CHART AUDIT

Best Practice Guideline Name and Code: Asthma

Patient ID #:
Agency/Site #:
Date Data Collected: (day) (month) (year)
Data Collector’s Initials:

Client Eligibility Criteria (all eligibility criteria must be met to proceed)

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Patients who present themselves to the participating units (Emergency/Urgent Care,
Clinical Decision Unit, and Medical Unit) with a primary or secondary diagnosis
of asthma.

Note: Patients in acute or unstable conditions are not included until stabilized.

1. Unit of origin:
2. Primary diagnosis:
3. Other diagnosis:
4. Date or Birth: (day) (month) (year)
5. First language:
6. Written information on asthma provided to patient ❏ yes ❏ no
7. Was baseline teaching information on asthma
provided to patient by a nurse? ❏ yes ❏ no
 Nursing Best Practice Guideline
Adult Asthma Care Guidelines for Nurses: Promoting Control of Asthma
Evaluation Tools

8. Has the patient come to the hospital with presenting

problem of asthma in previous 12 months? ❏ yes ❏ no

9. Was the level of asthma control documented for:

a) medication use ❏ yes ❏ no
b) use of ß2 agonist (Ventolin, Bricanyl) ❏ yes ❏ no
c) experience of daytime symptoms ❏ yes ❏ no
d) experience of nighttime and/or awakening symptoms ❏ yes ❏ no
e) physical activity ❏ yes ❏ no
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f) absence from school or work ❏ yes ❏ no
g) exacerbations ❏ yes ❏ no
h) other, specify

10. Was an individualized asthma action plan developed

for the client’s discharge? ❏ yes ❏ no

11. Was respiratory assessment done? ❏ yes ❏ no

 Nursing Best Practice Guideline
Adult Asthma Care Guidelines for Nurses: Promoting Control of Asthma
Evaluation Tools

PATIENT INTERVIEW IN HOSPITAL

Best Practice Guideline Name and Code: Asthma

Patient ID #:
Agency/Site #:
Date of interview: (day) (month) (year)
Interviewer Initials:

Client Eligibility Criteria (all eligibility criteria must be met to proceed)

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Patients who present themselves to the participating units (Emergency/Urgent Care,
Clinical Decision Unit, and Medical Unit) with a primary or secondary diagnosis
of asthma.

Patient must speak English or French.

Note: Patients in acute or unstable conditions are not included until stabilized.

Introduction:
Hello. My name is _________. The Trillium Health Centre is participating in a Best Practices
project for nurses caring for patients with Asthma. I would like to ask you a few questions
about your hospital experience. The interview will take about 5 to 10 minutes. Do you
have any questions about your participating in this interview at this point?

Please remember that your participation is voluntary and that you may choose not to
answer any question or stop the interview.

Please feel free to ask questions at anytime during the interview.

Let’s get started.

 Nursing Best Practice Guideline
Adult Asthma Care Guidelines for Nurses: Promoting Control of Asthma
Evaluation Tools

Interview
1. Did the nurse ask you to demonstrate the use of your inhaler or puffer?
(mark one answer only) ❏ yes
❏ no
❏ don’t know

2. Do you have an asthma action plan to manage your asthma symptoms?

❏ yes
❏ no (GO TO QUESTION 3)
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a) If yes, was your action plan developed or reviewed with you by a nurse?
❏ yes
❏ no

3. Did a nurse assess or teach you about the following:

yes no don’t know
a) Basic facts about asthma? ❏ ❏ ❏
b) The use and reason for your medications? ❏ ❏ ❏
c) Did the nurse assess or teach you about early ❏ ❏ ❏
warning signs of worsening asthma?

If patient uses MDI or a Turbuhaler, ask question 4.1

If patient uses a Diskus, ask question 4.2
 Nursing Best Practice Guideline
Adult Asthma Care Guidelines for Nurses: Promoting Control of Asthma
Evaluation Tools

4.1 Could you demonstrate to me how you take your inhaler?

Assess technique

Yes (1) No (0)

Patient removes cap/cover of mouthpiece and:

shakes (if using MDI) OR

twists base ring (if using Turbuhaler) OR
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puts in spacer (if using MDI plus spacer)

Exhales (FRC)

Inhale appropriately for device

slow inhalation (for Metered Dose Inhaler) OR

quick (for Dry Powder Inhaler)

Holds breath (for close to 10 seconds)

Exhales

Total Score
 Nursing Best Practice Guideline
Adult Asthma Care Guidelines for Nurses: Promoting Control of Asthma
Evaluation Tools

4.2 Could you demonstrate to me how you take your Diskus inhaler?

Assess technique

Yes (1) No (0)

Patient uses the thumb to open the outer cover.

click will be heard.
Patient then uses the thumb to click second lever.
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Again a click will be heard

Exhales

Inhale appropriately (quick deep breath)

Holds breath (for close to 10 seconds)

Exhales

Total Score

5. Would you be willing to participate in a 5 to 10 minute follow-up telephone

interview in 1 month that would ask you questions about your asthma control?
❏ yes ❏ no ❏ maybe

a) If yes, what is your telephone number?

b) Do you have an alternate phone number?

6. Do you have any other comments about the nursing care that you received for the
management of your asthma during your recent hospital visit?

Thank you for taking the time to participate

in this survey and answer all of these questions!
 Nursing Best Practice Guideline
Adult Asthma Care Guidelines for Nurses: Promoting Control of Asthma
Evaluation Tools

PATIENT FOLLOW-UP TELEPHONE INTERVIEW AT HOME

Best Practice Guideline Name and Code: Asthma

Patient ID #:
Agency/Site #:
Date of interview: (day) (month) (year)
Interviewer Initials:

Introduction:
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Hello. My name is _________. When you were in the hospital a month ago, you indicated
that you would be willing to participate in a telephone survey after you had returned home
from the hospital. I am calling to do the interview for that survey. Your opinions are very
important to us in order to evaluate the Asthma Care Best Practice Guidelines for nurses.

The survey will take about 5 to 10 minutes. Do you have any questions regarding your
participation in this interview at this point? Please remember that your participation is
voluntary and that you may choose not to answer any question or stop the interview.

I would like to ask you a few questions about your asthma control over the past month.

Please feel free to ask questions at anytime during the interview.

Let’s get started.

 Nursing Best Practice Guideline
Adult Asthma Care Guidelines for Nurses: Promoting Control of Asthma
Evaluation Tools

Interview: The following questions relate to your asthma experience in the hospital.

1. Do you remember the asthma action plan for handling your asthma symptoms
that you and your nurse developed or reviewed when you were in the hospital?
❏ yes
❏ no
❏ don’t know

2. Have you looked at or referred to your asthma action plan to manage your asthma
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symptoms since being home from the hospital?
❏ yes
❏ no
❏ don’t know

3. Did the nurse review with you how to properly use your puffer/inhaler?
❏ yes
❏ no
❏ don’t know

4. When you left the hospital, were you given information about the following
community resources?
yes no don’t know
a. Trillium Health Centre – Asthma Education Center ❏ ❏ ❏
b. Asthma Society Help Line ❏ ❏ ❏
c. The Lung Association ❏ ❏ ❏
d. The Canadian Network of Asthma Care ❏ ❏ ❏
e. Internet Resources ❏ ❏ ❏
(e.g, Weather Network, Asthma Society,
Lung Association)
f. Other resources (please specify)
 Nursing Best Practice Guideline
Adult Asthma Care Guidelines for Nurses: Promoting Control of Asthma
Evaluation Tools

5. Did you telephone, visit or receive assistance from any of these resources?
yes no don’t know
a. Trillium Health Centre – ❏ ❏ ❏
Asthma Education Center
If yes, ❏ phone
❏ visit

b. The Asthma Society? ❏ ❏ ❏

If yes, ❏ phone
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❏ visit website

c. The Lung Association? ❏ ❏ ❏

If yes, ❏ phone
❏ materials mailed out
❏ visit website

e. The Canadian Network of Asthma Care? ❏ ❏ ❏

If yes, ❏ visit website

f. Family Physician ❏ ❏ ❏

g. Respirologist/Specialist ❏ ❏ ❏

h. Other resources, specify

 Nursing Best Practice Guideline
Adult Asthma Care Guidelines for Nurses: Promoting Control of Asthma
Evaluation Tools

The following 2 questions ask about your level of confidence about asthma.

6. On a scale of 1 to 10, how confident do you feel about being able to recognize when
your asthma is out of control, with 10 being extremely confident and 1 being not at
all confident that you know when your asthma is out of control?

1 2 3 4 5 6 7 8 9 10
not at all extremely
confident confident
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7. On a scale of 1 to 10, how confident do you now feel that you know what to do when
your asthma starts to get out of control, with 10 being extremely confident and
1 being not at all confident that you know what to do when your asthma starts to get
out of control?

1 2 3 4 5 6 7 8 9 10
not at all extremely
confident confident

Thank you for taking the time to participate

in this survey and answer all of these questions!