As an AHSN we’re committed to spreading innovation across healthcare. The overarching objective of the national Adoption and Spread Safety Improvement Programme (A&S-SIP), which closed in March 2022, was to identify and support the spread and adoption of effective and safe evidence-based interventions and practice. A new safety improvement programme will focus on system safety.
Each of the four objectives of this programme intended to make medical procedures, and discharges from acute settings, as safe as possible whilst driving forward innovation within healthcare.
The national A&S-SIP was led by NHS England and Improvement. The programme was delivered locally by the West of England Patient Safety Collaborative.
Our local delivery (to March 2022) was focussed on meeting the objectives of the national A&S-SIP:
- Support an increase in the proportion of patients in acute hospitals receiving every element (for which they are eligible) of the British Thoracic Society COPD discharge care bundle;
- Support an increase in the proportion of eligible sites adopting three evidence-based tracheostomy safety interventions;
- From April 2021, support an increase in the proportion of patients in acute hospitals receiving every element (for which they are eligible) of the asthma discharge care bundle.
- From April 2021, to support an increase in the proportion of patients receiving all elements (for which they are eligible) of the emergency laparotomy care bundle.
Read more about our work (click the links to jump to the relevant project):
Asthma and COPD resources for clinicians: beyond the bundles
In November 2021, to coincide with COPD Awareness Month, the West of England AHSN ran a virtual event in collaboration with South West and Wessex AHSNs. This event ‘Beyond Bundles’ aimed to promote the use of the COPD and Asthma discharge bundles but also to look beyond them at other factors that can lead to readmissions, so that healthcare teams could start to address these while delivering the care bundles. Access the resources here.
COPD Discharge Care Bundle
COPD is the second most common lung disease in the UK with an estimated 1.2 million people living with the condition. The British Thoracic Society (BTS) developed a COPD Discharge Care Bundle with the aim of improving care and reducing readmissions for patients admitted with an acute exacerbations of COPD (AECOPD).
The COPD Discharge Bundle describes five high impact measures which reduce the number of patients who are readmitted following discharge from hospital after an AECOPD.
COPD Discharge Care Bundle elements:
- Review patients’ medication and assess inhaler technique
- Provide written self- management plan and emergency drug pack
- Offer referral for smoking cessation (where appropriate)
- Assess suitability for pulmonary rehabilitation
- Appropriate follow-up call within 72 hours of discharge
Interim results shared to mark COPD Awareness Month, November 2021:
We supported our acute trusts to improve the use of the COPD Discharge Bundle, with the aim of 80% of patients receiving all suitable elements. Read interim project results in our news article to mark COPD Awareness Month in November 2021. Results included a 34% increase (to June 2021) in the number of patients receiving all elements (for which they are eligible) of the COPD Discharge Bundle.
COPD Quality Improvement reports:
- Read the COPD QI report from Bristol Royal Infirmary respiratory team here.
- Read the COPD QI report from Great Western Hospital respiratory team here.
- Read the COPD QI report from Royal United Hospital Bath respiratory team here.
- Read the COPD QI report from Gloucestershire Hospitals respiratory team here.
COPD Digital CHAMP
Outside of the A&S-SIP commission, we are also supporting one of our local systems to roll out a COPD self-monitoring app. The project is working with digital champions across the Bristol, North Somerset and South Gloucestershire (BNSSG) system to roll out myCOPD, alongside North Bristol NHS Trust.
Asthma Discharge Bundle
The National Review of Asthma Deaths (NRAD), 2014, found that 46% of asthma deaths were identified as being avoidable if appropriate guidelines were followed. It found that only 23% of people that died from asthma had Personal Asthma Action Plans (PAAPs) in place despite being acknowledged to improve asthma care. Additionally, prescribing errors were widespread, with excessive prescribing of reliever medication, under prescribing of preventer medication and inappropriate prescribing of long-acting beta agonist (LABA) bronchodilator inhalers. These findings prompted the British Thoracic Society to develop a care bundle for asthma.
The BTS Asthma Discharge Bundle, developed in 2015, is primarily for patients discharged from emergency departments following an acute asthma attack, but is also suitable for use in admissions wards where circumstances permit. The bundle can be applied to both adults and children over the age of 2.
The bundle consists of five elements as listed below, each of which have been demonstrated to improve patient outcomes:
- Assessment of inhaler technique
- Review of medications
- Provision of a written action plan and patient self-management plan
- Consideration of triggering and exacerbating factors
- Appropriate follow up arrangements
We supported our acute trusts to implement and improve the use of the Asthma Discharge Bundle, with the aim of 80% of patients being assessed for all elements.
Outside of the A&S-SIP commission, we have been supporting NHS organisations to increase the adoption and spread of three Rapid Uptake Products (RUPs) including biologics for treating severe asthma (Reslizumab, Benralizumab, Mepolizumab and Omalizumab) and measuring fractional exhaled nitric oxide (FeNO) concentration in asthma.
Safe Tracheostomy Care Programme
The Safe Tracheostomy Care Programme aimed to work with teams across the acute sector to improve their tracheostomy safety and care within their hospital. This programme links in with the National Tracheostomy Safety project (NTSP).
To support the programme’s delivery, a new Tracheostomy Toolkit (in PDF format) was developed by the NTSP and AHSNs to support teams across England adopt and use these safety interventions.
To do this, we have worked with our acute teams to establish their use of the following three evidence-based tracheostomy safety interventions;
- Bedhead signs for patients
- Standardised ‘bedside’ tracheostomy emergency equipment
- Standardised tracheostomy daily care bundle
Through a community of practice of staff involved in tracheostomy care, we facilitated shared learning to improve the consistency of the bundle elements as well as identifying any further areas for improvement.
In September 2021, we published an article showcasing the achievements of our tracheostomy community of practice. Read more about those successes, and what’s next, here.
Emergency Laparotomy Collaborative
A precursor to our project called PreciSSIon (Preventing Surgical Site Infection across a region), the West of England AHSN formed part of the Emergency Laparotomy Collaborative, which works with hospitals across three Academic Health Science Networks. Read more about PreciSSIon here.
Emergency laparotomy is a major surgical procedure, with 30,000 to 50,000 performed every year in the UK. However at the time the Collaborative was established (in 2015) around 15% of patients were reported to die within 30 days of surgery. Over 25% of patients remained in hospital for more than 20 days after surgery, costing the NHS over £200m a year. Whilst these figures have improved since 2015, patient safety during and after emergency laparotomy remains a key priority for the NHS. Find out more about the Emergency Laparotomy Collaborative here.
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