Applying a quality improvement approach to mobilising knowledge in COPD: developing and implementing a care bundle
1. Applying a quality
improvement approach to
mobilising knowledge in
COPD: developing and
implementing a care bundle
Laura Lennox
NIHR CLAHRC for Northwest
London
2. CLAHRC NWL Approach
Quality
Improvement
Quality Improvement Methods
Patient and
Public
Engagement
Engaging Patients and Staff
Research
Rigorous Design and Use of
Data
Education
Training, Support and
Collaboration
A collision of different worlds…
NIHR CLAHRC
For Northwest London
Health Outcomes
Patient Experience
Improve health outcomes and patient experience through translating
research evidence into practice.
Primary aim:
3. • 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
4. Distilling the evidence
• 5 key elements
for acute
exacerbation of
COPD
• Ideal for
development into
a Care Bundle
• Piloted in 1 site
5.
6. CLAHRC NWL QI tools and methods
Systematic and
scientific
approach to
implementation
using quality
improvement
tools and
techniques
7.
8. ACTIO
N
EFFEC
T
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
4
2
1. Readmissions
2. Attendances at Smoking cessation
3. Referrals to smoking cessation
4.Number of bundles completed
A
A Guidelines
A
A
13. • 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
14. Challenges and FacilitatorsChallenges and Facilitators
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)
15. In summary QI methods aid
teams to…
• Act Scientifically and Pragmatically
• Engage and empower patients and staff
• Embrace complexity
• Support long term success
Although this seems like a relatively simple intervention, maintaining 100% delivery was very difficult. We wanted to find out not only the key challenges to implementing the bundle but also understand the solutions used by the teams to overcome these barriers to inform future implementation. 3 focus groups: Collated documentary evidence and asked team to rate their biggest challenges. The top three staffing challenges were: Staff too busy Lack of staff engagement Added workload of the bundle Facilitators: Bundle responsibility: Having a multidisciplinary team deliver the bundle emerged as a common solution across all sites. Finding Bundle champions : aided in education and motivation to complete the bundles. Message was better received from a person seen as being part of the team. Changing Perceptions: Participants identified that a solution to some of the staffing issues included changing the perceptions of those delivering the bundle. Take home messages: Even something as easy as the bundle is not easy to implememnt. There has been increasing enthusiasm to adopt the COPD bundle across the region but the implementation of new interventions poses challenges to both those planning and delivering such initiatives. Understanding and learning from the challenges faced by previous endeavours and the facilitators to overcoming these barriers provides an opportunity to mitigate issues that cost time and resource and ensure training tailored to the anticipated challenges.