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TSANZ Ann Woolcock Young Investigator Awards Oral bs_bs_banner Respirology (2016) 21 (Suppl. 2), 21–100 doi: 10.1111/resp.12754 TO 002 Nurses SIG Symposium Part 1 Oral Presentations NURSES SUPPORT DELIVERY OF SPIROMETRY TO TOP END RESPIRATORY OUTREACH CLINICS: A REVIEW OF THE TO 001 SERVICE EXPANSION AND DEVELOPMENT OF SYSTEMS HARWOOD S, O’LOUGHLAN M Royal Darwin Hospital INCIDENCE AND OUTCOMES OF ACUTE RESPIRATORY ILLNESS (ARI) WITH COUGH IN URBAN INDIGENOUS CHILDREN Introduction/Aim: Chronic lung conditions are a major cause of morbidity and mortality among Indigenous Australians in remote communities across HALL K1, CHANG A1,2,3,ANDERSONJ4, ARNOLD D1, KEMP A4,O’GRADY K1 the Northern Territory (NT) Top End. The Royal Darwin Hospital (RDH) respi- 1Queensland University of Technology, 2Menzies School of Health Research, ratory service commenced on site in 2010 and identified a lack of spirometry Charles Darwin University, Darwin, 3Department of Respiratory Medicine, testing at remote community health clinics. Remote outreach clinic planning Queensland Children’s Health Services, Brisbane, 4Murri Health Group, prioritized the provision of nurse led spirometry testing so essential for access Caboolture to early detection, diagnosis and monitoring of chronic lung conditions. We performed a review of the service to monitor the expansion including spirom- etry numbers and systems used for the performance and recording of spirom- Introduction: Studies suggest that 10% of children with an ARI have etry tests obtained from a cohort of 408 clients from 21 remote clinics. persistent cough at day 21. There are no studies in Indigenous children who Methods: have a high risk of chronic lung disease. We aimed to identify the incidence • We performed a retrospective review of spirometry numbers from 21 and outcomes of ARI with cough as a symptom in urban Indigenous children. remote clinics from 2013 to 2015. Methods: This is a prospective study of Indigenous children aged <5years • We reviewed the current service and the relevant literature, and we registered with a primary health service. Children are followed for a period of consulted with the Alfred Hospital Lung Testing Laboratory to examine their 12 months via monthly contacts. Children who develop cough as a symptom systems. at any time are followed weekly for 4 weeks to ascertain cough outcomes. • We analysed the current systems used to record the spirometry data in the Results: To date, 162 children are enrolled, totalling 1065 child-months of health information systems. observation. Two-hundred ARI episodes with cough have been reported (29.6 Results: episodes/100 child-months at risk). Thirty-four ARIs (17%) have progressed to 1 Numbers expanded from 66 spirometry tests performed in 21 remote persistent cough at day 28 in 24 children. Of these, 15 children had 1 episode, clinics in 2013, 210 in 2014 and 132 in 2015; data collection is ongoing. 5had2,4had3and1had4duringthefollow-upperiod.Themajorityof 2 We developed a unit quality assurance programme and a remote spirome- children with persistent cough were diagnosed (by a respiratory physician) try policy and procedure to provide quality and standardized tests. with protracted bacterial bronchitis and/or bronchiectasis. 3 In 2013, 66 spirometry test results were shared with other health profes- Conclusions: The proportion of children developing persistent cough post- sionals only in respiratory physician letters. In 2014, 210 spirometry tests were ARI is higher than that currently reported (10%) with the majority suggesting also shared into the remote electronic information systems. In 2015, 132 spi- protracted bacterial infection. rometry tests were also shared in the (RDH) acute information system and re- Grant Support: A QUT APA award, a QCMRI Program Grant, UQ Founda- ported on by our respiratory physicians. tion Research Excellence Award, a QUT Indigenous Health Research Start- Conclusions: The expansion of the (RDH) respiratory service improved Up Grant and the NHMRC CRE for Lung Health in Aboriginal and Torres Strait access to quality spirometry testing for those with chronic lung conditions in re- Islander Children. mote Top End clinics. Spirometry data are shared with health professionals Declaration of Interest: None to Declare across the remote and acute health settings of the (NT) Top End. Further inno- vative methods are now required to provide both access and shared spirome- try information across health settings. Grant Support: None, nothing to declare. © 2016 The Authors. Respirology © 2016 Asian Pacific Society of Respirology 22 Respirology (2016) 21 (Suppl 2), 21–100 TO 003 Nurses SIG Symposium Part 2 Oral Presentations ESTABLISHING CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) COMPLIANCE AMONG THE SOCIO-ECONOMICALLY DEPRIVED SOUTH AUCKLAND POPULATION BY INTRODUCTION OF COMMUNITY BASED NURSE-LED TO 004 CLINICS AND WALK-IN CLINICS KARUMALIL J, HERATH S AN EVALUATION OF OUTREACH RESPIRATORY NURSING Middlemore Hospital, Auckland, New Zealand PRACTICE FOR THE MANAGEMENT OF COPD COMPARED TO NURSING BEST PRACTICE GUIDELINES: OBSERVATIONAL COHORT STUDY OF CHANGES OVER TIME Introduction/Aim: Patient compliance is the key to successful CPAP ther- apy. The lower socioeconomic status and dominance of non-European eth- 1,2,3 1,2,3 1,2,3 1,2,3 1,2,3 nicity with higher prevalence of obstructive sleep apnoea (OSA) in our ROYALS K ,LAWTONK , KOPSAFTIS Z , CARSON K ,SMITHB 1The Queen Elizabeth Hospital, South Australia, 2Clinical Practice Unit, Basil patients pose a marked hindrance to CPAP compliance. 3 This 6-month quality control audit (from July 2013) aims to measure CPAP Hetzel Institute for Translational Health Research, South Australia, School of compliance in the above group, following introduction of community-based, Medicine, The University of Adelaide, South Australia nurse-led clinics and walk-in clinics. Methods: In order to provide a CPAP device, all patients had auto set pres- Introduction/Aim: Respiratory nursing best practice guidelines for COPD sure determination following the diagnosis of OSA, facilitated by sleep nurses, were released in 2005 by the Registered Nurses Association of Ontario. An 6-weeks post-treatment compliance is assessed in the sleep nurse clinic. audit of patients attending the Respiratory Nursing Service (RNS) at The Patients had the facility to come to a walk-in clinic, staffed by community Queen Elizabeth Hospital (TQEH), Adelaide, South Australia in 2006 revealed healthcare workers; supervised by a sleep nurse specialist, 5 days of the poor compliance to these guidelines. Therefore, the aim of this study was to week without appointments, for troubleshooting. determine if compliance to these best practice guidelines had improved for Results: Of the 3782 patients currently on CPAP, 123 were audited during COPD patients in the Respiratory Nursing Service. this period. Seventy-three percent (n = 91) were male. Mean age was Methods: A 12-month retrospective observational cohort study was con- 51 years. (range 21–79 years). Mean AHI 36.4/h. Majority were non-European ducted through review of medical records, internal respiratory databases (67%) (Table 1). and electronic patient record systems. All new patients admitted to the RNS In the total group, 60% (n = 74) had CPAP usage of >4 h, demonstrating at TQEH with a diagnosis of COPD in 2013 were included. Data were a marked success in this group, as >4 h compliance is not achieved by extracted into a standardized pilot-tested template and were analysed using 46–83%. In our group, only n = 31 (25%) did not have >4 h compliance. Microsoft Excel 2010. The most compliant are NZ European n = 30/41 (73%) and least compliance Results: Thirty-eight patients were included in the audit. By 2013, the in Samoan n = 9/20 (45%) (Table 1). guideline recommendations which had poor compliance in 2006 showed In keeping with published standards, 14.5% (n = 18) failed to continue to use marked improvement, and the % change for these included: referral offered the CPAP in 1–5months. to pulmonary rehabilitation (59%), use of qualitative tool for dyspnoea assess- Conclusion: Despite socio-economic barriers, we have achieved excep- ment (63%), nutritional status (66%), discussions on advanced care planning tional CPAP compliance exceeding the published rates and kept the refusal (53%), smoking cessation strategies (76.5%) and sputum clearance (70.2%). at accepted levels, whilst using home auto set titration as the initial pressure Full compliance to the guidelines was documented for assessment of hypoxia determination mode. and review of oxygen flow rates for patients with oxygen therapy. Areas still We believe this success is due to nurse-led clinics and community walk-in found to have poor compliance overall with the guideline include checking of clinics that cater to the needs of the patient by providing patient education inhaler technique (50%) and completion of a COPD action plan (26%). and support outside the hospital setting. Conclusions: Guideline compliance has improved within the Respiratory Grant Support: none Nursing Service over time. Variances between staff documentation practices may account for slower improvement in some areas. However, time con- Table 1. CPAP compliance (by ethnicity and number of hours used) when straints, patient refusal and a lack of applicability to some guidelines may also measured at 6 weeks post-commencement, following in home auto set pres- be a factor contributing to poor compliance. This suggests that a revision of the sure determination in the socio-economically deprived
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