Background School personnel in contact with students with life-threatening allergies often lack necessary supports, creating a potentially dangerous situation. Sabrina’s Law, the first legislation in the world designed to protect such children, requires all Ontario public schools to have a plan to protect children at risk. Though it has captured international attention, the differences a legislative approach makes have not been identified. Our study compared the approaches to anaphylaxis prevention and management in schools with and without legislation. Methods Legislated (Ontario) and non-legislated (Alberta, British Columbia, Newfoundland and Labrador, and Quebec) environments were compared. School board anaphylaxis policies were assessed for consistency with Canadian anaphylaxis guidelines. Parents of at-risk children and school personnel were surveyed to determine their perspectives on school practices. School personnel’s EpiPen technique was assessed. Results Consistency of school board policies with anaphylaxis guidelines was significantly better in a legislated environment (p=0.009). Parents in a legislated environment reported more comprehensive anaphylaxis emergency forms (p< 0.001), while school personnel in non-legislated environments reported more comprehensive forms (p=0.004). Despite school personnel in both environments receiving EpiPen training (>80%), suboptimal technique was commonly observed. However, school personnel in the legislated environment had better technique (p < 0.001). Conclusion Our results suggest that school boards in legislated environments have made greater efforts to support students at-risk for anaphylaxis compared to non-legislated environments. However, significant gaps exist in both environments, especially with respect to EpiPen administration, content and distribution of anaphylaxis emergency forms, and awareness of school procedures by school personnel and parents.
Objective: We sought to determine whether a standardized emergency department (ED) asthma care pathway (ACP) for adults would be accepted by ED staff, improve adherence to Canadian ED asthma management guidelines and improve patient outcomes. Methods: Ten Ontario hospital EDs (5 intervention, 5 control) participated in a 5-month pre-post intervention study. Emergency department management, admissions, repeat ED visits and ED length of stay were compared between sites and by ACP use versus nonuse at intervention sites. Results: The ACP was used in 101 of 383 visits (26.4%) at 5 intervention sites. Use of the ACP varied significantly between sites, ranging from 6% to 60% (p < 0.001). When compared with control sites, there were significant increases in the use of metered dose inhalers (MDIs), inhaled steroids, referrals, documentation of teaching, patient recollection of teaching (all with a p < 0.001) and oxygen (p = 0.001). Use of peak expiratory flow rate (PEFR) measurements decreased in both intervention and control sites. Increased PEFR documentation and systemic steroid use in the ED and on discharge were only found in patients who were on the ACP at intervention sites. Admissions increased from 3.9% to 9.4% at intervention sites in contrast to control sites, where they remained fairly stable (p = 0.016), but did not differ by ACP use. The length of stay for discharged patients increased by a mean of 16 minutes for ACP patients at intervention sites (p = 0.002). There were no statistically significant differences in repeat ED visits. Conclusion: Adoption of a standardized ED ACP for adults is highly variable. Despite modest uptake, which averaged 26%, beneficial changes in specific aspects of asthma care delivery were found, notably in referrals and recollection of teaching done during the ED visit, without a substantial increase in ED length of stay. These changes may lead to improvements in outcomes, such as reduced relapse rates, which this study was not designed or powered to detect. Provincial and national implementation strategies that address barriers to clinical pathway adoption are warranted and have the potential to improve adherence to guidelines and outcomes for asthma patients. RÉSUMÉObjectif : Nous avons voulu vérifier si un plan clinique standardisé pour le traitement de l'asthme chez l'adulte serait accepté par le personnel des urgences et s'il allait promouvoir l'observance des lignes directrices canadiennes pour la prise en charge de l'asthme aux urgences et améliorer le pronostic des patients. Méthode : Dix services d'urgence d'hôpitaux en Ontario (5 appliquant l'intervention et 5 témoins) ont participé à cette étude pré-et post-intervention d'une durée de 5 mois. Nous avons comparé la prise en charge, les admissions, les visites multiples et la durée du séjour aux urgences entre les différents services, selon qu'ils appliquaient ou non le plan clinique. Résultats : Cinq services d'urgence assignés au groupe appliquant l'intervention ont effectivement utilisé le plan clinique lors de 101 c...
Clinical pathways provide an outline for evidence-based care and can reduce variation of care across many healthcare settings including the emergency department (ED). The purpose of this study was to examine healthcare providers' perceptions of an ED Asthma Care Pathway (EDACP) and identify barriers to implementation. Following a 6-month pilot implementation of the EDACP, healthcare providers (physicians, nurses, respiratory therapists, and administrators) at 5 Ontario EDs were surveyed about the content, format, and usefulness of the pathway, as well as barriers to implementation. A focus group was convened to further explore these factors. In total, 207 of 338 mailed surveys were returned. Approximately 60% of respondents felt that the pathway was a useful tool, which enabled adherence with asthma guidelines (81%), decreased variation in patient care (79%), decreased uncertainty in patient management (73%), and increased their knowledge of best practice (87%). Time constraints and length of the pathway were common barriers. Healthcare providers perceive the EDACP to be a useful knowledge translation and guideline implementation tool, which promotes best practices. Although barriers to adoption of the tool have been identified, these may guide content revisions and inform the process for a successful provincial implementation strategy.
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