Applying a quality improvement approach to mobilising knowledge in COPD: developing and implementing a care

bundleLaura Lennox

NIHR CLAHRC for Northwest London

CLAHRC NWL Approach

Quality Improvement Quality Improvement

Methods

Patient and Public

Engagement Engaging Patients and Staff

ResearchRigorous Design and Use of

Data

Education Training, Support and

Collaboration

A collision of different worlds…

NIHR CLAHRCFor Northwest London

Health OutcomesPatient

Experience

Improve health outcomes and patient experience through translating research evidence into practice.

Primary aim:

• 5th Leading cause of death in the UK

• Leading reason for hospital admission and readmission

• Large economic burden to the NHS

• NICE – COPD guidelines: 183 recommendations

Why COPD? Chronic Obstructive Pulmonary Disease

Distilling the evidence

• 5 key elements for acute exacerbation of COPD

• Ideal for development into a Care Bundle

• Piloted in 1 site

CLAHRC NWL QI tools and methods

Systematic and scientific approach to implementation using quality improvement tools and techniques

ACTION

EFFECT

To improve quality of care for patients

with an acute exacerbation of

COPD at Hospital X

Appropriate provision of clinical care

COPD Care bundle

Referral to pulmonary rehabilitation where

appropriate

Information on condition provided to

patient

Referral to smoking cessation if patient is

smoker

Patients taught correct inhaler

technique

1

3

42

1. Readmissions

2. Attendances at Smoking cessation

3. Referrals to smoking cessation

4.Number of bundles completed

A

A Guidelines

A

A

Model for Improvement

Aims

Measures

Testing change

In Practice:

Bundle design and administration

• Increased compliance with care standards

• Over 1400 patients have been put on the bundle

• 945 have received all elements (67.2%)

Impact on Quality of Care

Challenges and Challenges and FacilitatorsFacilitators

1) Staff too busy “Having multidisciplinary people get involved helps with the initiation of the bundle. Because even if one person misses it a physio or nurse comes and starts it and even a pharmacist can say this patient isn't on a bundle and start one.” (Physiotherapist)

2) Lack of staff engagement“Having a nurse champion or a bundle nurse aided in getting people on board and motivated staff members to complete the bundles.”(Consultant)

3) Added workload of the bundle “A large part was changing the perception of the bundle, they envisaged it as more time consuming than it actually was, because they are constantly being given more paperwork around various diseases and to them it was just another piece of paper that they thought would be a lot of work.” (Nurse)

In summary QI methods aid teams to…• Act Scientifically and Pragmatically

• Engage and empower patients and staff

• Embrace complexity

• Support long term success

Contact information

Laura Lennoxl.lennox@imperial.ac.uk369 Fulham RoadSW10 9NHLondonUnited Kingdomhttp://www.clahrc-northwestlondon.nihr.ac.uk/