COPD Secondary Care Audit Good Practice Repository – Discharge bundles Version 1: June 2018

Introduction The National Asthma and COPD Audit Programme (NACAP) have collated a series of case studies which highlight good practice in both audit data collection and entry, and in provision of quality COPD care. This document aims to provide teams with learning to implement locally, and with ideas on how local practice could be improved.

As part of the snapshot secondary care organisational audit (conducted between 3 April and 30 June 2017) question 6.9 of the dataset requested to develop and submit an improvement plan based on the audit data. Following an extensive review of the submitted plans some selected examples of good practice have been included. These entries can be identified by the asterisk (*) which follows their and trust name.

Do you have any questions? If you have any questions about any of the content, or would like more detail about any of the case studies, please contact the NACAP team on 020 3075 1526 or via email ([email protected]).

For further information on NACAP, please visit www.rcplondon.ac.uk/nacap.

Contents

Hull Royal Infirmary (Hull and East Yorkshire Hospitals NHS Trust) ...... 2 Lister Hospital (East and North Hertfordshire NHS Trust) ...... 2 Royal Hospital (The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust) 2 Darent Valley Hospital (Dartford and Gravesham NHS Trust)*...... 2 Hospital (Poole Hospital NHS Foundation Trust)...... 3

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The national average of the percentage of patients receiving a discharge bundle upon discharge is 67.5%. (Calculated between May 2017 and May 2018)

Hull Royal Infirmary (Hull and East Yorkshire Hospitals NHS Trust)

 The Acute Respiratory Assessment Service (ARAS) Nearly 60% of patients at Hull Royal consists of four specialist nurses. Infirmary receive a discharge bundle.  The ARAS team are responsible for completing the Best Practice Tariff discharge bundle and the early supported discharge package, with support from the consultant and ward teams, as well as in conjunction with the lung function, home ventilation and other sub-speciality respiratory services as required.

Lister Hospital (East and North Hertfordshire NHS Trust)

 Discharge bundles are begun upon first contact with the patient. Since May 2017 over 85% of patients at  During the daily check of the patient system, the clinical Lister Hospital received a discharge nurse specialists (CNS) will visit any patients found to be bundle. still in the hospital, both to complete the audit data collection and the discharge bundle.

To find out more, contact details for Lister Hospital can be obtained from the COPD audit team.

Royal Bournemouth Hospital (The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust)

 The local audit team work with a dedicated team of two Over 80% of patients at Royal health care assistants who complete all of the COPD discharge Bournemouth Hospital receive a bundles for the team. discharge bundle.  The team work together to ensure that as many discharge bundles are completed as possible.

Darent Valley Hospital (Dartford and Gravesham NHS Trust)*

 A discharge bundle was implemented in order to improve the uptake of referral to smoking cessation, Between March and December 2017 on improve continuation of care and to improve the rates of average over 60% of patients at Darent referral to pulmonary rehabilitation. Valley Hospital received a discharge  The new discharge bundle was reviewed and agreed and bundle. added to the patient system pre-populated with patient demographics to allow easy access to all clinical staff.  Some elements of the discharge checklist have also been added to the electronic discharge notification as compulsory fields to be filled in for any patient with an acute exacerbation of COPD.  Rescue packs are also available and can be provided on patients discharge.  PR referrals have been made much less time consuming with the introduction of a shorter process referral is now via the trusts online service making referrals much less time consuming.

Good Practice Repository – Discharge bundles | Version 1: June 2018 National Asthma and COPD Audit Programme [email protected] | 020 3075 1526 | www.rcplondon.ac.uk/nacap

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Poole Hospital (Poole Hospital NHS Foundation Trust)

 The Dorset Adult Integrated Respiratory Team (DAIRS) at Poole Hospital screen the Acute Assessment Unit identifying patients requiring completion of the discharge bundle and then meet to discuss the priorities for the day.  An electronic ‘contact sheet’ is used to identify all aspects of the bundle that have been undertaken and is completed by the team on individual electronic patient record, thereby identifying a date and time and a reason why any aspect of the bundle may have been left incomplete.  The recently appointed senior health care assistant provides assistance with aspects of the bundle.  DAIRS are looking to introduce a ‘screensaver’ across Trust PCs to promote awareness of the need for all COPD patients to be referred to the team.

To find out more, contact details for Poole Hospital can be obtained from the COPD audit team.

Good Practice Repository – Discharge bundles | Version 1: June 2018 National Asthma and COPD Audit Programme [email protected] | 020 3075 1526 | www.rcplondon.ac.uk/nacap

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