1
Acknowledgements Simon Bass, Wendy Grealy, Wendy Hubbard, Judith Hallam, Clinical Redesign School, Medical Ward Staff, Patients with COPD, Duane Kelly, Nicole Jenson Case for Change Variation in clinical practice is common despite agreed clinical practice guidelines. Following the ‘Leading Better Value Care’ audit undertaken for South East Regional Hospital Bega, patients with COPD had clear gaps between effective evidenced based practice (EBP) and actual service provision 6. This occurred despite agreed and documented TSANZ guidelines 1. Unwarranted clinical variation highlighted system inefficiency, unsustainable resource allocation and ‘less than best’ clinical quality and safety for 50% of patients at risk of over - oxygenation and for 80% of patients not receiving spirometry. Goal Elimination of unwarranted clinical variance (adherence to TSANZ guidelines) in the management of South East Regional Hospital patients with COPD, will improve the patient experience, system efficacy and health outcomes . Objectives Increase Oxygen prescription therapy appropriately prescribed targets from 50% to 60% by July 2019. Increase Spirometry from 10% to 40% by October 2019. Establish a COPD Support team by November 2019 using existing resources and cost neutral to service. Method Breathe Easy Project followed the ACI Clinical Redesign methodology and utilised a wide range of tools including: Staff Interviews (n=40): Patient Interviews (n=13): Patient Journey Mapping: Brain Storming (n=26): Root Cause Analysis: Logic mapping and Process Mapping (n=24): Dot - O - Metre solution prioritisation votes (n=15) Breathe Easy: Eliminating Unwarranted Clinical Variation for the Patient with COPD Interim Results October 2018 Full Evaluation December 2019 will measure: Percentage of completed spirometry prior to discharge (Target 40%) Percentage of admitted patients with O2 variance charted (Target 60%) Percentage of completed Proms and Prems (Target 80%) Sustaining change Regular feedback of data will be provided to Medical Ward Staff following trends of outcomes against TSANZ Guidelines Outcomes Review the consequences of the changes that have been made – quantitative data (check sheets, tally tool computer system eMR search and surveys) Conclusion Refine training needs after staff evaluation and outcome measures Test understanding and use of TSANZ guidelines for spirometry, breathlessness/oxygen prescription by clinical lead and COPD Support team at weekly Multidisciplinary meetings with monthly data showcasing current outcome measures and communication plan releases Contact Christine Sullivan – RN, MN (NP), MPallCare (Aged Care), MHlthSc (Gerontology), GradCertClMan, MACN, MTSANZ, STTI Psi Eta Chapter Nurse Practitioner, Chronic and Complex Care Phone: 02 6491 9800 Email: [email protected] Root Causes - SPIROMETRY Staff Knowledge Limitations: (People) Application Limitations: Opt-In System (Process) Patient Knowledge Limitations (People) Root Causes - OXYGEN Staff Knowledge Limitations (People) Application Limitations Between the Flags (Policy) Patient Knowledge Limitations (People) 0 10 20 30 40 50 60 70 80 90 Spirometry Oxygen Trending Improvement against TSANZ Guidelines 2017 (n=40) 2018 (n=17) Percent COPD Care Bundle for all patients Spirometry attended GP and patient informed of current plan Breathlessness Treated Oxygen Prescription if indicated SpO2 <88% WHY don’t I need oxygen when breathless? Could someone please explain? Spirometry…I’ve NEVER had that in hospital
