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

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Published on June 18, 2013

Author: ckforum

Source: slideshare.net

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2013 Canadian Knowledge Mobilization Forum
Laura Lennox
NIHR CLAHRC for Northwest London

Applying a qualityimprovement approach tomobilising knowledge inCOPD: developing andimplementing a care bundleLaura LennoxNIHR CLAHRC for NorthwestLondon

CLAHRC NWL ApproachQualityImprovementQuality Improvement MethodsPatient andPublicEngagementEngaging Patients and StaffResearchRigorous Design and Use ofDataEducationTraining, Support andCollaborationA collision of different worlds…NIHR CLAHRCFor Northwest LondonHealth OutcomesPatient ExperienceImprove health outcomes and patient experience through translatingresearch evidence into practice.Primary aim:

• 5thLeading cause of death inthe UK• Leading reason for hospitaladmission and readmission• Large economic burden tothe NHS• NICE – COPD guidelines:183 recommendationsWhy COPD?Chronic Obstructive Pulmonary Disease

Distilling the evidence• 5 key elementsfor acuteexacerbation ofCOPD• Ideal fordevelopment intoa Care Bundle• Piloted in 1 site

CLAHRC NWL QI tools and methodsSystematic andscientificapproach toimplementationusing qualityimprovementtools andtechniques

ACTIONEFFECTTo improve qualityof care for patientswith an acuteexacerbation ofCOPD at Hospital XAppropriateprovision ofclinical careCOPD CarebundleReferral to pulmonaryrehabilitation whereappropriateInformation oncondition provided topatientReferral to smokingcessation if patient issmokerPatients taughtcorrect inhalertechnique13421. Readmissions2. Attendances at Smoking cessation3. Referrals to smoking cessation4.Number of bundles completedAA GuidelinesAA

Model for ImprovementAimsMeasuresTesting changeIn Practice:

Bundle design andadministration

• 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 FacilitatorsChallenges and Facilitators1) Staff too busy“Having multidisciplinary people getinvolved helps with the initiation ofthe bundle. Because even if oneperson misses it a physio or nursecomes and starts it and even apharmacist can say this patient isnton a bundle and start one.”(Physiotherapist)2) Lack of staff engagement“Having a nurse champion or abundle nurse aided in getting peopleon board and motivated staffmembers to complete thebundles.”(Consultant)3) Added workload of the bundle“A large part was changing theperception of the bundle, theyenvisaged it as more time consumingthan it actually was, because they areconstantly being given more paperworkaround various diseases and to them itwas just another piece of paper thatthey thought would be a lot of work.”(Nurse)

In summary QI methods aidteams to…• Act Scientifically and Pragmatically• Engage and empower patients and staff• Embrace complexity• Support long term success

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

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