The Case for a COPD Discharge Bundle CQUIN in London

The case for a COPD discharge bundle CQUIN in London

Why COPD? right incentive to prioritise this. It is also a COPD accounts for a significant number of light-touch approach as it incentivises admissions, readmissions and bed days in improvements in at least five evidence- England and in London. In 2008-09 the based interventions. And whilst the total number of bed days in London for ultimate aim is to keep people out of emergency hospital admissions for COPD hospital as much as possible, hospitals will as a primary diagnosis was 91,140. There continue t care for many people with is significant unwarranted variation which COPD because it is a progressive, terminal the consultative national strategy (“the disease that can cause frightening Strategy”) aims to address and which the breathlessness and also because there NHS London Respiratory programme remain many undiagnosed people living in intends to reduce in London. the community. Therefore a hospital CQUIN is valid. Why discharge? Patients discharged from hospital following What is the bundle proposed? an exacerbation of COPD have high levels of depression (64%) and anxiety (40%) (i) Referral to smoking cessation service if and uncertainty that drives help seeking a current smoker; (ii) Assessment of behaviour. Therefore there is a need for suitability and/or enrolment into a improved hospital discharge procedures pulmonary rehabilitation programme; (iii) and community follow-up – including the Have appropriate education, written provision of pulmonary rehabilitation and information, self management plans and encouragement of self-management rescue packs for future exacerbations; (iv) strategies1i. This is reinforced in the Ensure that patient understands their Strategy. medications and have demonstrated good inhaler technique whilst on the wards; (v) Why a bundle approach? Ensure that they have appropriate follow The Strategy includes a number of up once discharged from hospital. These evidence-based recommendations. The five elements are included in a checklist – bundle incorporates the important ones to see appendix. The checklist can be improve patient safety and quality of care printed onto sticky labels that can be stuck by acute trusts. These bundles are already into the person’s notes, completed by the in use in four London acute trusts: clinician – eg the respiratory nurse Imperial, Chelsea and Westminster, North specialist, before discharge and easily West London and St Georges following a located by the coder. systematic literature review by CLAHRC. The bundle should be used and applied to Numerator: Number of patients admitted every patient admitted with a primary with HRG code DZ21A-K as primary diagnosis of an acute COPD exacerbation diagnosis and are discharged with a whether on a respiratory ward or acute completed care bundle medical assessment unit or other medical wards. It should be personalised to the Denominator: Number of patients individual – not all components are needed admitted with HRG code DZ21A-K as for everyone. In this way it has the power primary diagnosis to change clinical behaviour and achieve sustainable change. Payment threshold: 75% in year one 2011/12 and 95% in year two 2012/13. Why a CQUIN? The bundle is a major step-up in care, but The bundle can be altered for local usage will only have a meaningful impact if it is and can be updated into a collection tool implemented across a trust, requiring with ease. clinical leadership and management intervention. The CQUIN provides the Appendices include example of patient checklist, and also clinician checklist 1 Gruffydd-Jones K et al. What are the needs of S Williams L Restrick patients following discharge from hospital after an acute exacerbation of chronic obstructive pulmonary disease (COPD)? Prim Care Resp J 29 November 2010 2007;16(6):363-368. 1 The case for a COPD discharge bundle CQUIN in London - checklist

2 09/06/2010 CHRONICThe case for OBSTRUCTIVE a COPD discharge PULMONARYbundle CQUIN in London DISEASE - checklist (COPD) DISCHARGE CARE BUNDLE Summary – This care bundle is a group of evidence based items that should be delivered to all patients being discharged from the hospital following an Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD). The care bundle aims to improve quality of care, patient experience and minimise the risk of re- hospitalisation. To ensure t he bundle can apply to all we have prepared a combination of actions and documents to facilitate the discharge process. Inform the COPD specialist of all COPD patients within 24 hours of arrival including patients discharged . Put patients sticker on this form and ward and fax to Hammersmith 33066 or Charing Cross 17044 Patient Sticker CARE BUNDLE STEPS All required documents are included in package.

1. If patient is a smoker offer smoking Non Smoker or Completed Declined N/A Ward: ______cessation assistance GO TO 2. Pulmonary rehabilitation screened for suitability Patient COPD First point of contact, either by the CNS Nurses or Physiotherapist, who Referral Made Declined N/A will assess and refer patient. Nurse to contact if not done prior to Safe Discharge discharge (fax referral form) Checklist 3. Self Management Management Plan Oxygen Alert Card Breath Easy Rescue Pack To be completed by nurse with the patient. n/a n/a

4. Satisfactory use of inhalers demonstrated and understood Nurse (Initials) Please assess during medication rounds. Observe the patients using the Satisfactory device(s) and document on electronic prescribing record adequate technique Checklist Referral Made demonstrated. (Refer to pharmacist or CNS if extra support is needed). Completed Date:___/___/___ 5. Follow up arrangements made and given to patient Spirometry on discharge Patient should see respiratory medical specialist and COPD respiratory nursing specialist within 1 month of discharge. Outpatient Appointment Requested

Community Appointment Requested

Care bundle components are based on: NICE COPD guidelines 2004 (1-5) A Patient Experience Survey CLAHRC team April 2009 (6)3 Systematic Literature Review supported by CLAHRC April 2009 (1-6) Chelsea and Westminster Hospital COPD Discharge Care Bundle i