This document discusses developing and implementing a care bundle for patients experiencing acute exacerbations of chronic obstructive pulmonary disease (COPD) using a quality improvement approach. It identifies COPD as the fifth leading cause of death in the UK and outlines five key elements that were distilled from clinical guidelines to form the basis of the care bundle. The care bundle was piloted at one hospital site with the goals of improving quality of care for COPD patients and reducing readmissions. Challenges to implementation included perceived increased workload and lack of staff engagement. Facilitators included designating nurse champions and involving multidisciplinary teams. Over 1400 patients received the bundle, with 67.2% receiving all elements.

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

6. CLAHRC NWL QI tools and methods
Systematic and
scientific
approach to
implementation
using quality
improvement
tools and
techniques

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

11. Model for Improvement
Aims
Measures
Testing change
In Practice:

12. Bundle design and
administration

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

17. Contact information
Laura Lennox
l.lennox@imperial.ac.uk
369 Fulham Road
SW10 9NH
London
United Kingdom
http://www.clahrc-northwestlondon.nihr.ac.uk/