Using the Omaha System to disseminate evidence-based practice for asthma care at the individual and community levels

Background and Issues - A State Health Department Asthma Program discovered the widespread use of the Omaha System for individual level practice in local public health (LPH) agencies. However, they noted the lack of individual and community level asthma pathways. One LPH agency created Omaha System pathways based on best asthma care for home visits and community interventions.

Description - Public health nurses, Omaha system expert, respiratory therapist, certified asthma educator, health educator and asthma program planner were convened to develop pathways for asthma care home visits, and for community level asthma interventions. Graduate nursing students critiqued the pathways for alignment with current evidence and national asthma guidelines. Their recommendations were incorporated within the pathways. A KBS rating guide to supplement the two pathways was developed. A program evaluation was conducted using Problem Rating Scale Outcomes data related to the problems incorporated within the pathways. The completed pathways were disseminated to LPH agencies. A survey was conducted to determine alignment with current practice.

Lessons Learned – Designing pathways to be incorporated within any electronic documentation system based on the Omaha System was important to ensure use. Creating a multi-disciplinary team including professionals and students improved the pathways. This project is an exemplar of using standardized language combined with evidence from literature to guide practice at the individual and community levels.

Recommendations – Using an iterative process is needed for creating and critiquing evidence-based pathways. The pathways should be used to disseminate best asthma care practices in a standardized way to LPH agencies.