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Prescription of Single Maintenance And Reliever Therapy (SMART) for moderate and severe persistent asthma is the most important and actionable improvement in the National Heart Lung Blood Institute (NHLBI) asthma guidelines for pediatric hospitalists. SMART is the use of a single inhaled corticosteroid/long acting beta agonist inhaler both as a daily preventive inhaler and as-needed for asthma symptoms. As hospitalists, we treat patients with poorly controlled asthma who will benefit from SMART asthma action plans. Despite ample evidence supporting use of SMART, implementation of such large changes in practice is challenging. Implementation science and quality improvement principles can be used to anticipate barriers and plan effective frameworks for increasing use of new guidelines in practice. Through work at our own institutions, we have identified common barriers to implementing the new SMART guidance. While no single solution is likely to lead to widespread uptake, multi-pronged efforts can support adoption of this practice change. In this session, we will review the new NHLBI asthma guidelines relevant to pediatric hospitalists, focusing on when and how to use SMART for our patients with asthma. Using historical experience in implementation of other care guidelines, we will discuss implementation barriers that have been described and may apply to SMART. We will share the experience with SMART at our own institutions and tools used for inter-disciplinary guideline dissemination and SMART implementation. Our goal is to aid attendees in creating organized changes in local practice. Attendees will receive an actionable toolkit to bolster efforts in implementation of SMART at their institutions. This toolkit will include quality improvement and implementation tools useful for targeting institution-specific barriers and tracking progress of SMART use.
When and Where Presented
Pediatric Hospital Medicine 2022 Conference ; July 28-31, 2022; Lake Buena Vista, Florida
Hogan, Alexander; Kyler, Kathyrn; and Seguin, Claire, "Get SMART: Implementation of Updated Asthma Guidelines for Pediatric Hospitalists" (2022). Presentations. 72.