Click to add title

Click to add title

Outcomes from the Secondary Care COPD Audit 2014 Findings and quality improvement National Chronic Obstructive Pulmonary Disease (COPD) Audit Programme 2017 The audit programme partnership Working in strategic partnership: Supported by: Commissioned by: Outcome report Reported outcomes for patients whose index admission with COPD exacerbation occurred during the 2014 secondary care audit in England. The outcomes examined:

Mortality Readmissions Length of stay In admission, preadmissions were also looked at. Outcomes were sourced by linking audit data to data held by the Hospital Episode Statistics (HES) and the Office for National Statistics (ONS). Included in the outcome report 183 hospitals 12,594 patients Inpatient mortality

7.9% 7.8% age Treatment with NIV 4.3% ITU assessment need comorbidities Associated with inpatient mortality

Initial acidotic pH MRC score it 20 14 au d it au d 20 08 au d

it DECAF score 20 03 Chest x-ray consolidati on GOLD stage Mortality within 30/90 days of index admission Within 90 days: 16.3% COPD was the main cause of death.

14.2% 12.0% 2003 audit 2008 audit 2014 audit 30 days: 71% 90 days: 67% Mortality within 30/90 days of index admission NIV Longer length of stay Increasing age Higher mortality

within 30/90 days associated with*: Dementia / confusion Cardiovascular disease Kidney disease Chest x-ray consolidation * All P < 0.05 Higher DECAF score Length of stay (LOS) There has been a reduction in LOS (6 days 2003, 5 days 2008, 4 days 2014). Chest x-ray consolidation Higher MRC and DECAF

score Number of comorbidities Age * P < 0.001 Higher GOLD stage Lower pH Associated with increasing LOS* Receipt of NIV

Readmission 30/90 days after index discharge Patients who were readmitted for any reason within 30 days (24%), and within 90 days (43%). 12% were readmitted at least once within 30 days owing to COPD. 23% were readmitted at least once within 90 days owing to COPD. Readmission 30/90 days after index discharge Readmission rates increase with:* * P < 0.01

Deprivation Age Number of co morbidities Longer LOS Disease severity markers Higher MRC score Higher GOLD stage Low initial pH NIV management on HDU during admission

Previous/recent admissions prior to the index admission 65% of patients had 1 admission in the prior 365 days 36% of patients had 1 admission in the prior 90 days 51% of patients had 1 admission in the prior 180 days Use QI methodology to plan/enact your methodology a) Work as a team b) Decide what you want to improve c) Use a driver diagram to identify the drivers for change

d) Plan your change using a PDSA template e) Have clear lines of responsibility f) Meet regularly to performance manage yourselves SMART Aim development should focus on SMART objectives. Look for areas where you can realistically make improvements. Build a team and understand your stakeholders. Plan how you will achieve your aim. What measures will you use to show you are improving? S Specific

M Measurable A Achievable R Realistic T Time bound Driver diagrams To decide what to start on for your overall improvement aim, you may find it helpful to use a driver diagram. The Institute for Healthcare Improvement has a helpful guide on how to

use them http://www.ihi.org/resources/Pages/Tools/Driver-Diagram.aspx AIM PRIMARY DRIVERS SECONDARY DRIVERS Driver diagrams COPD example AIMS PRIMARY DRIVERS Maximise oxygen prescription using target saturations To ensure safe and appropriate administration of oxygen to those admitted with AECOPD

Ensure safe titration of oxygen Ensure all staff are trained in oxygen administration SECONDARY DRIVERS Develop policy that all inpatients have a target saturation prescribed on admission Incorporate prescription into electronic or paper prescription charts Use visible cue to target oxygen saturations at bedside eg oxygen target saturation wristbands

Flow chart to aid healthcare staff with titration Ensure oxygen safety training is accessible to all Incorporate oxygen safety into induction for medical, pharmacy, nursing and healthcare assistants Establish oxygen safety group incorporating patient safety, respiratory physician, anaesthetics, pharmacy, nursing, education and communication departments Use national audit to feedback performance Reduce harm events resulting from oxygen

Model for improvement and PDSA cycles To plan your change, it is important to regularly measure and study your activity using: Model for improvement What are we trying to accomplish? How will we know that a change is an improvement? What changes can we make that will result in improvement? Act Plan Study Do If the first cycle of improvement does not achieve the requisite change, you may need to try again with a second innovation.

Quality Improvement Example: Patients are not receiving NIV in a timely way. Plan: Investigate the number of patients admitted who currently receive NIV and the time at which they receive it (BTS guidelines recommend patients receive NIV within one hour). Act: Identify gaps in your improvement & speak to those who can help Do: Make changes based on your findings: *Add a question to admission proforma asking if NIV was considered Study: Plot the change over time

Quality Improvement Example: Low usage of discharge bundle potentially increasing readmission rates. Plan: Investigate the number of patients admitted who currently receive the discharge bundle (you can use the runcharts in the continuous audit) Act: Identify gaps in your improvement and speak to those who can help Do: Implement the use of a discharge bundle notification system at admission Study: Has the rate improved? Useful QI resources Respiratory Futures Forum http://www.respiratoryfutures.org.uk /copdsecondarycareauditforum

/ Login and share learning and suggestions about the audit. The British Thoracic Society QI site has a range of resources available https://www.brit-thoracic.org.uk/sta ndards-of-care/quality-improvement / Useful QI resources The Institute for Healthcare Improvement (IHI) http://www.ihi.org has a host of resources. Healthcare Improvement Scotland also has a range of resources http://www.healthcare improvementscotland.

org / What happens next? Use the audit web-tool to collect your data to support your local QI initiatives: www.copdaudit.org Use the online reporting and run charts so you can track your progress. View the good practice repository available on our website: https:// www.rcplondon.ac.uk/projects/ou tputs/secondary-care-workstream -audit-resources National COPD Audit Programme [email protected] 020 3075 1526 / 1566 / 1565 www.rcplondon.ac.uk/COPD

Recently Viewed Presentations

  • Facilitators of School Improvement January 2016

    Facilitators of School Improvement January 2016

    John Hattie and Helen Timperley (2007) The power of feedback. Review of Educational Research. Creating a Formative Assessment System. Every lesson must have an established purpose. ... Facilitators of School Improvement January 2016 Last modified by:
  • Le Son A  Two distinctive A sounds but

    Le Son A Two distinctive A sounds but

    Le Deuxième Son . The a is sometimes pronounced further back in the mouth like ah, art, alms in English and with the lips more rounded than for the a sound described previously: This sound is becoming obsolete, but technically...
  • Viruses in Biotechnology - Institute of Food and Agricultural ...

    Viruses in Biotechnology - Institute of Food and Agricultural ...

    Viruses in Biotechnology Dr. James Maruniak pGenBac2.1 is a transfer vector for high level eukaryotic expression of recombinant proteins in insect cells. This vector is compatible with Invitrogen Bac-to-Bac Baculovirus Expression System. The gene of interest can be easily cloned...
  • Financial Management FOR A SMALL BUSINESS Welcome 1.

    Financial Management FOR A SMALL BUSINESS Welcome 1.

    If you need to plan for a large expenditure, such as an equipment purchase or moving to a new location, a cash flow projection is the perfect tool. Similarly, if you have a seasonal business with large inventory purchases, a...
  • title

    title

    Bill Hammond• Corné Kreemer • Shelley Olds Phil Resor• Nancy West. UNAVCO & PBO. UNAVCO: non-profit consortium that provides geodetic research support. Manages Plate Boundary Observatory (PBO): NSF EarthScope's GPS network of 1100 stations
  • Your clinic - HPLC at 139 Club

    Your clinic - HPLC at 139 Club

    The HPLC assisted 12 new clients during the pilot at Bric Housing, indentifying and addressing the following legal needs: Client Issue 1 Issue 2 Issue 3 Issue 4 1 Debt 2 Removal from Housing Dept list Accessing super 3 Removal...
  • An Gnáthrud le Deirdre Ní Ghrianna Is gnáthfhear é Jimí ...

    An Gnáthrud le Deirdre Ní Ghrianna Is gnáthfhear é Jimí ...

    Bhí gnáthchlann acu:-John, Elizabeth agus Margaret. ... Tá Jimmy tuisceanach agus cairdiúil leo beirt. JIMMY. Fear maith grámhar iontaofa (good loving reliable man) is ea é. Oibríonn sé go crua (hard worker) mar bhríceadóir ar mhaithe lena theaghlach.
  • Basic Tasks - West Virginia University

    Basic Tasks - West Virginia University

    For the purposes of this article, the following words shall have the meanings hereafter ascribed to them unless the context clearly indicates otherwise:(d) "Valuation commission" or "commission" means the commission created in section three of this article.(h) "Electronic" means relating...