Asthma Team Evaluation & Management Task Checklist

Asthma Team Evaluation & Management Task Checklist Team should be using a collaborative, team-based approach: 1. Performing their role & responsibilities as listed below, 2. Agreeing to be accountable to diagnostic evaluation and 3. Including patient, family and friends in action plan development which emphasizes trigger avoidance.

Date Patient Name Patient MRN

PCP/Clinicia Caregiver Name n

PCP/Clinicia MFC Asthma Educator Other Responsibilities n (MD, NP, PA) Pre-visit Date Date Date Date Review patient record in EHR Schedule tests, including allergen test when appropriate Contact patient to confirm appointment and remind him/her to get labs done and bring all medications to visit Visit Date Date Date Date Clinical Assessments Complete patient health history and get date of last emergency department visit if applicable Assess asthma control with spirometry, peak flow meter, QOL, ACT and other tools at recommended intervals Evaluate patient for signs of impairment and risk (exacerbations) Assess use of rescue inhaler and frequency of exacerbations Review current medications (including over the counter and vitamins) Assess for therapeutic side effects and management plan adherence Management Review labs, including allergen test when appropriate, and exam results Order & administer annual flu shot if needed Develop or revise treatment plan based on clinical assessments Develop written action plan and set goals with patients Create list of triggers/allergens to avoid Coordinate referrals to specialists as needed Education & Engagement Use teach back method to ensure that patient understands his or her disease, therapy, and self-management tasks Evaluate health literacy and barriers to care, including cultural considerations Educate patient on importance of environmental controls Teach trigger avoidance and educate patient on seasonal environmental factors Reinforce key points in action plan and treatment plan Refer patient to portal Refer patient to home visitation program (if available) Refer patient to pick-up medication Encourage patient to call with questions Asthma Team Evaluation & Management Task Checklist Schedule follow-up visit before patient leaves the clinic Post-Visit Date Date Date Date Updated EHR with treatment plan, action plan, and additional clinical information One-week post-appointment call patient to assess barriers to adherence and compliance and to motivate As needed, call patient to remind them of appointments, new prescriptions, refills and tests