Implementing a COPD care bundle- the Southend experience

Dr Duncan PowrieConsultant Chest Physician

March 2015

• 2010 discharge checklist first developed• Completion rates were poor• Lack of responsibility for actions• No clear division between nursing and medical

responsibility for tasks• Discharge checklist meant often left until day

of discharge• Only implemented on respiratory wards

Attempted improvements

• Care bundle• Nominated professionals for each action• Column on whiteboard

• However when audited completion rate was only 30%

Aims

• 100% completion rate• All wards – respiratory and GIM

• Involvement of community teams

COPD CQUINN

• Joint project with community services• Bundle agreed• Project manager appointed (band 6) assisted

by COPD nurse• Completion recorded on systmOne• Community staff informed and all patients

followed up and bundle completed

Yes No 0

10

20

30

40

50

60

70

80

90

100

9

91

Do they require self management plan?

No

of

pa

tie

nts

Yes No na0

10

20

30

40

50

60

70

31

3

66

0xygen alert provided for T2RF?

No

of

pa

tie

nts

YesNo

na

Readmitte

d befo

re fo

llow u

p

RIP b

efore

follo

w up

0

20

40

60

80 69

141

7 9

Patients receiving respiratory follow up

No

of

pa

tie

nts

15 referred to LTC

• 100% of patients are given leaflets and education regarding COPD.• 100% of patients are given advice on flu and pneumonia vaccines.• 45% of patients where referred for assisted discharge (RRT). • 65% of patients where referred to LTC (Although this includes all first admissions

which is typically 35-40% of our overall admissions)

Other bundle elements

What have we learnt?

• Implementing the bundle is easier said that done

• Ongoing education, commitment and badgering is insufficient

• Dedicated individual with responsibility is required