During COPD Awareness Month, the acute hospitals in the West of England have been celebrating their work to improve patient safety as part of the NHS England and Improvement Adoption and Spread Safety Improvement Programme. This has 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.
The British Lung Foundation describes COPD as a group of lung conditions that make it difficult to empty air out of the lungs because the airways have become narrowed. This causes breathlessness. Worsening of breathlessness (often as a result of infection) is called an exacerbation. Exacerbations of COPD are one of the leading causes of hospital admission, and readmission following exacerbation also occurs frequently. All admissions to hospital have a negative impact on patients both physically and psychologically. Reducing the impact of admissions for lung disease is one of the key ambitions of the NHS Long Term Plan.
Adoption and spread of the COPD Discharge Bundle
Providing COPD patients with a number of simple interventions while they are in hospital, can reduce the chance of readmission. These interventions (listed below) form the COPD Discharge Bundle:
- Inhaler technique assessed and corrected
- Patient or carer has written information & understands their self-management plan
- Provision of rescue medication packs
- Smokers referred for smoking cessation
- Assessment for enrolment in pulmonary rehabilitation
- Appropriate follow-up arranged within 72 hours
The National Patient Safety Improvement Programme project – which started in November 2019 – has focussed on increasing the use of all appropriate elements of the bundle. This work has been coordinated across the region by the West of England AHSN alongside each of our acute hospital trusts:
- Gloucestershire Hospitals NHS Foundation Trust (GHT)
- Great Western Hospitals NHS Foundation Trust (GWH)
- North Bristol Trust (NBT)
- Royal United Hospital Bath NHS Foundation Trust (RUH)
- University Hospitals Bristol and Weston Foundation Trust (UHBW)
Improving patient safety
Since commencing the project, we have seen some significant regional and local improvements in delivery of the bundle:
- 34% of patients in the West of England region received every element of the bundle (for which they are eligible) in June 2021, up from 0% in November 2019.
- From April to June 2021, between 66-71% of COPD patients across the West of England were provided with a self-management plan.
- In June and July 2021, 100% of GHT COPD patients had their inhaler technique checked.
- In June 2021, 91% of GWH COPD patients who smoke were offered smoking cessation support.
- In July 2021, 95% of RUH COPD patients were assessed for their suitability for pulmonary rehabilitation.
- In RUH and GWH over 90% of COPD patients had a follow-up appointment arranged.
Working collaboratively to drive improvement
Through a West of England network, the respiratory teams have worked collaboratively to collectively share ideas and overcome barriers to optimise the use of the bundle.
Alongside improvements made to the delivery of the bundle, each team has also completed their own local quality improvement (QI) project to improve aspects of patient care. These projects are related to the bundle elements, including upskilling staff on Brief Intervention Training for smoking cessation, reviewing self-management plans and delivering training to improve front door diagnosis. The outcomes of these projects will be shared and celebrated through the month of November.
Mark Juniper, Respiratory Consultant and Clinical Lead at the West of England AHSN said:
It has been great to work with the teams from different hospitals on this project for the last two years. Despite the pressure on respiratory services during the pandemic, they have managed to improve the care of patients with COPD. This work has provided an ideal focus for improvement and bringing the teams together to share ideas and what they have learned has been really exciting.
On 9 November, we are running a joint event with the South West and Wessex AHSNs on the wider aspects of COPD and asthma care. This event is now fully booked however recordings of a number of the sessions will be available afterwards, so please join our waiting list.
The West of England AHSN are also celebrating COPD Awareness Month – and World COPD Day on 17 November – throughout November on Twitter. This will include showcasing the QI projects undertaken by each respiratory team.
Updated 26 November – COPD Quality Improvement reports:
- Read the QI report from Bristol Royal Infirmary (part of UHBW) respiratory team here.
- Read the QI report from Great Western Hospital respiratory team here.
- Read the QI report from Royal United Hospital Bath respiratory team here.
- Read the QI report from Gloucestershire Hospitals respiratory team here.
The COPD Discharge Bundle is one element of the national Adoption and Spread Patient Safety Improvement Programme. Find out more about our work on the programme here.