1. The Implementation of a COPD Discharge Care Bundle Louise Sewell Clinical Lead for Pulmonary Rehabilitation & COPD Nurse Specialists Services

2. Who? Why? When? How?

3. Care bundle UHL Local CQUIN 2012-13 COPD Care Bundle

4. Why? Approx 150 patients with COPD discharged from Glenfield each month 1/3 discharged with REDS 2/3 discharged with no co-ordinated support from UHL

5. Process Mapping: Feb 2012 Poor coordination of follow up support. Lack of understanding of roles. Duplication of tasks Lack of collaborative working. Poor levels of staff COPD knowledge in ward and HCP staff Inefficiencies Why?

6. CLAHRC Rehabilitation Implementation team – managed Sally Boyce Established team of COPD specialist nurses – REDS team Busy Pulmonary Rehabilitation team already providing post exacerbation PR SPACE manual developed on site Supported by NHS Improvement Lung team Who?

7. Our Approach Task & Finish group established specifically to implement. Strong desire to change current practice on speaking with clinical staff. Opportunity to review existing services & specialist roles. Opportunity to integrate specialist services – PR & REDs. Opportunity to integrate SPACE as part of the COPD care bundle (implementation). PPI involvement. How?

8. Improvements in knowledge How? SPACE e-learning programme Completed by ward nurses, OTs and Physiotherapists Led to a14% increase in knowledge levels as measured by the Bristol COPD Knowledge Questionnaire

9. Sept 2011 Set up task & finish group – meet regularly to discuss process, paperwork and implementation Sept 2012Jan 2012 Contents of bundle agreed Changes to REDS team management Staff SPACE training begins April 2012Feb 2012 REDS team begin to pilot bundle REDS team deliver bundle to all their patients Local CQUIN commences 6 month data analysis Implementation phase Operational phase When?

11. COPD Care Bundle Process Stage 1 Care Bundle delivered by REDS prior to discharge Stage 2 Post discharge phone calls by REDS@ 2 days and 15 days Stage 3 Assessment for Pulm Rehab within 4 weeks of discharge

12. So where are we? Commenced by REDS team April 2012 Initiated for all COPD discharges (codes J41 - 44) Adopted as a local CQUIN Projected totals of pts on care bundle by end of March 2013 = 1096 out of 1654 discharges

13. So where are we? Total to date = 586

14. REDS Care Bundle Data: Number of home visits completed COPD CARE BUNDLE

15. # phone calls per patient REDS Care Bundle Data: Number of phone calls received per patient

16. Impact on length of stay?

17. REDS Care Bundle Data: Smoking Cessation Uptake

18. REDS Care Bundle Data: Referral to Pulmonary Rehabilitation

20. What we have learnt… Task and finish group was crucial to making this happen Make friends with your business data analyst Ensure that your team has adequate knowledge and skills Identify a team who will ‘gatekeep’ the project Endorsement from the medical team is essential Accept that you won’t get it right first time…