Pursuing Perfection: School Nurses Key to Asthma Project at Cambridge Health Alliance

​Cambridge Health Alliance (CHA), a health care system in Massachusetts (USA) that serves the residents of Cambridge, Somerville, and Boston’s Metro-North region, has identified local school nurses as valuable members of their Pursuing Perfection Pediatric Asthma Project team. The partnership with school nurses is key to CHA’s efforts to improve the health of and care provided to children with asthma, and decrease emergency visits, missed school days, and primary care visit time.
Children with asthma may see their primary care team only a few times a year, while school nurses have ongoing contact and proximity to these same children. By monitoring children with asthma, school nurses can identify early asthma symptoms, administer rescue inhalers, provide self-care information, and prevent unnecessary emergency department visits. These are just a few examples of the critical role school nurses can play to decrease the effect of asthma on children and the health care system.
According to the project team, an important system that was developed was a communication plan between school nurses and the primary care team. School nurses frequently had questions, but did not know how or when to best reach pediatricians. Today, a communication system, utilizing a written asthma action plan and email, pagers, or telephones, has been established to ensure ongoing feedback between the school nurses and the primary care team in a timely manner. CHA’s asthma registry will soon be available to the school nurses, which will further improve communication and assist in care delivery.
CHA has also developed and distributed asthma educational materials so that children and parents receive consistent information both at school and at their doctors’ offices. Before the initiative, educational materials handed out at schools often varied from those handed out by primary care teams. The discrepancies proved to be confusing for patients and families in their self-management.
Currently, school nurses join the Asthma Project team every two weeks for a one-hour meeting. Other members of the project team include respiratory therapists, pediatricians, nurse practice managers, a representative from the Information Technology department, and the planned care coordinator. There are two school nurses on the team, representing both Somerville and Cambridge elementary schools. According to the team members, the perspective from both sides has mutual benefits in designing new processes for asthma care with children, and they are collecting data to determine the effectiveness of this partnership and new system.

CHA is finding that the school nurse partnership model’s success may extend well beyond childhood asthma. An example of the extension is demonstrated by physician reports that they now are receiving emails and other communications from the school nurses regarding co-managing other common pediatric conditions. This realignment of existing structures (i.e., school nurses and primary care teams) is building bridges to overall improvements in delivery of pediatric care.
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