COPD, OPIOIDs, DMARDs

COPD -Aim: 100% of all COPD patients to receive optimal care in a safe standardised process An up-to-date smoking history Has cessation advice recorded yearly in non-smokers and at every visit in smokers Is there documented spirometry and chest x-ray for all patients with diagnosed COPD Has the patient’s ability to use an inhaler device has been assessed by a nurse or doctor in the past six months Documented evidence of advice on physical activity including pulmonary rehabilitation and self-management education where appropriate Documentation of vaccination status pneumococcal and influenza) status with appropriate recalls Overall compliance

Discuss your Experience So Far What did your data show? What changes have you made? What have been you key successes? What have been the challenges? What are you going to do next?

COPD- Key Change Ideas Information leaflets to patients In-house spirometry – cost, training Shared Medical Appointments COPD register COPD nurse lead clinic COPD patients being enrolled onto Planned Proactive Care COPD template for every visit COPD book created in-house for target audience Refer patients to Better Breathing courses Routine and opportunistic screening – smokers, over 42 years – spirometry and CXR.

Opioids -Aim: 100% of prescribing for Opioid Derived Analgesia will follow a safe standardised process Is there a clear indication within the clinical record for a moderate to strong opioid derived analgesic to be used/initiated? Is there evidence that the analgesic ladder has been used prior to the patient being prescribed a moderate to strong opioid derived analgesic? Is there a clear management plan? (side effects, breakthrough pain, self- management) If a repeat prescription had been ordered earlier than expected is there evidence of discussion with the patient Has clinical review occurred effectively prior to the second prescription being issued? Have all measures been met?

Opioid Prescribing

Quaymed

Apollo

Discuss your Experience So Far What did your data show? What changes have you made? What have been you key successes? What have been the challenges? What are you going to do next?

Opioids- Key Change Ideas Handouts to patients - Health Navigator has excellent resources All GPs are prescribing safely according to the analgesic ladder Opioids prescribing process is streamlined Management plan clearly documented in notes Patient given clear instructions about potential side effects and when to report back to GP/nurse Developed PDSA cycles to inform the team of current tramadol prescribing process We hypothesised regarding GP prescribing habits, to identify differences between GP’s Attempt to “socialise” opioid prescribing policy amongst clinicians at the practice Update of locum / registrar orientation document to this effect Ensure whole practice team are familiar with CD handling and Rx processes Controlled drug Rx’s to be scanned into patient notes to ensure audit trail Elimination of “extra” CD Rx audit record New CD Rx pads received, continue to be documented in numerical sequence in CD register Explore possibility of coding for opioid prescribing.

DMARDs - Aim and Measures Aim: 100% of patients on Disease Modifying Anti-Rheumatics Drugs (DMARDs), particularly Methotrexate and Azathioprine, have their drugs safely prescribed and reliably monitored Has there been a full blood count in the past 12 weeks (AZA) / 8 weeks (MTX) as per local guidance? If any abnormal results in the previous 12 weeks (WBC <3.5 x 109/L, Neutrophils <2.0 x 109/L, Platelets <150 x 109/L, ALT >x2 upper limit (>60) has action been recorded in the consultation record? Is there a documented review of blood tests prior to issue of the last prescription? Has the patient ever had or declined an influenza vaccine in the last 12 months? Has the patient been asked within the last 3 months about any side effects, e.g. nausea, mouth ulcers, fever, sore throat, shortness of breath, diarrhea? Has the patient been given written information about the DMARD that they are taking within the last 12 months? Have all measures been met

Discuss your Experience So Far What did your data show? What changes have you made? What have been you key successes? What have been the challenges? What are you going to do next?

DMARDs- Key Change Ideas Template to record the monitoring and prescribing of these patients Recall systems so patient return to have their blood tests taken Ensuring patients are invited for influenza and pneumococcal vaccines Using Patient information leaflets from Safe Rx A variety of ways of ensuring patients have the regular blood tests, i.e. letters texting emailing Training health care assistants to ask about side effects of the drugs.