ECU Health’s Pediatric Asthma Program, which started in 1995, aims to reduce emergency department (ED) and inpatient admissions for children with asthma, decrease school absenteeism and increase the quality of life for asthmatic children in eastern North Carolina. One of the key ways it accomplishes these goals is through partnerships with eastern North Carolina public schools.
The program serves 29 counties in eastern North Carolina, many of which include rural areas. Contracts with schools are established so that members of the program’s team can perform asthma tests, communicate with parents, connect with primary care physicians and help ensure kids have access to and are compliant with their medications.
Bailey Edwards, RRT, a respiratory care manager with the program, works with students from elementary age to high school. She’s worked with DF Walker Elementary School in Edenton, North Carolina for seven years, but recently the school hired a new school nurse.
Typically, Edwards works with the kids one at a time, but since school began in August, she has been trying out a different approach. “The nurse started grouping the kids with asthma together for our sessions,” she said. “They’re all in the same grade and even in the same class. They all know each other. Treating them together created a community for the kids, where they see they’re not alone with their challenges.”
During a session, Edwards listens to the child’s lung sounds and performs an assessment, including a fractional exhaled nitric oxide (FeNO) test, which determines how much lung inflammation is present and how well inhaled steroids suppress that inflammation. She also makes sure the kids have their medications at school, that the meds aren’t expired and they are using their spacer devices correctly. She always gets the kids to demonstrate their inhaler technique, too. “They’re kids,” she reminded. “They want to take their two puffs and go out and play, but we want to be sure they’re using the proper technique to get the correct amount of medication.”
An added bonus to the group sessions is that the kids help each other learn more about asthma and their treatments. “Kids can hear from their parents and the nurse and from me,” Edwards said. “But when they hear information from their friends, they tend to remember it. During our sessions, the kids are excited to show what they know. They are learning how to take care of themselves.”
Parents also have the consistency of getting the same information from multiple sources. “They hear from me and the nurse, and from their kids,” Edwards shared. “This is another piece of the puzzle with asthma because it changes from day to day. You can look great on a Tuesday and then be in the ED on Friday with a flare.” When parents are better informed about their child’s disease process and how to recognize the signs and symptoms of a flare, they know how to handle it.
As a result, Edwards said the kids at DF Walker Elementary have flourished. “During the fall these kids were sick with the flu and strep and their FeNO tests weren’t good, but they kept working at it and trucking along, and now they’re testing normally and are so proud of themselves,” she said.
The statistics bear this out; in the past fiscal year, the program has seen increases in both school nurse referrals and PCP referrals, a 17.7% increase in school visits and a 21% increase in hours spent in clinic visits. “We are working hard to increase community numbers in order to decrease the number of kids in the hospital,” Sue Anne Pilgreen, manager for the Pediatric Asthma and Eastern Carolina Injury Prevention programs, said.
“School nurses are one of our strongest partners and patient advocates,” Pilgreen continued. “Especially in our rural counties where transportation and other social determinants of health can be a barrier. This partnership cuts down on the barriers and offers a win-win solution for everyone.”