Ortiz, Lisa DNP Project

Lisa Ortiz, DNP, MSN, RN

DNP: California State University, Fresno

Project Title: Closing the Gap in Pediatric Asthma Care: Improving PAS Documentation and Timeliness of Treatment in the Emergency Department

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Background: Pediatric asthma exacerbations are a common reason for emergency department (ED) visits and require timely assessment and intervention to prevent clinical deterioration. Evidence-based guidelines support the use of standardized scoring tools, such as the Pediatric Asthma Score (PAS), to guide treatment decisions and promote early bronchodilator administration. Despite these recommendations, inconsistent PAS use and variable adherence to standardized order sets may contribute to delays in care and variability in treatment.

Purpose: The purpose of this Doctor of Nursing Practice project was to improve early recognition and treatment of pediatric asthma exacerbations by increasing PAS documentation at triage and reinforcing use of the asthma order set in the emergency department. This project aimed to improve documentation compliance, evaluate door-to-albuterol timing, and assess order set utilization.

Methods: This quality improvement project used a retrospective pre–post design in a high-volume emergency department. The pre-intervention period occurred from January through August 2025, and the post- intervention period occurred from September through December 2025. The intervention consisted of staff education grounded in Knowles’ Adult Learning Theory, focusing on PAS scoring and workflow integration. Data were collected through chart audits and analyzed using chi-square testing and logistic regression with a significance level of .05.

Results: PAS documentation improved from 62.9% in the pre-intervention period to 78.8% in the post-intervention period, representing a 15.9% increase. This improvement was statistically significant, with an odds ratio of 2.19 and a 95% confidence interval of 1.29 to 3.72. Door-to-albuterol time did not demonstrate a statistically significant improvement, although median times remained within the organizational goal of less than 60 minutes. Asthma order set utilization remained unchanged between groups, indicating persistent provider- level variation.

Conclusions: Educational reinforcement effectively improved PAS documentation, demonstrating a meaningful change in nursing practice behavior. However, improvements in documentation did not translate into significant changes in clinical outcomes such as medication timing or order set utilization. These findings suggest that process improvements alone are insufficient to drive clinical change.

Implications for practice: Standardizing PAS use at triage supports early recognition of asthma severity and promotes more consistent clinical decision-making. Future efforts should focus on interdisciplinary collaboration, provider engagement, and integration of decision support within the electronic health record to improve both process and clinical outcomes.

Dr. Lynn Jakobs