FeNO testing improving asthma diagnosis in region

The West of England AHSN has been supporting several projects to implement FeNO testing in primary care over the past six months.  There are now 16 GP practices across the region that have access to FeNO devices, with a further 60 practices planning to go live in the next two months.  The South West Respiratory Clinical Network has provided funding for a further 7 devices across the West of England region which improves access for patients.

FeNO devices measure fractional exhaled oxide in the breath of patients, which provides an indication of the level of inflammation in the lungs.  This can be used to aid in the diagnosis of asthma.  It is a quick and easy test that can be carried out by any healthcare professional that has received training.  Benefits of FeNO testing include:

  • improved speed and accuracy of diagnosis for patients suspected of having asthma
  • improved patient care and outcomes, reducing the risk of exacerbations and hospital admissions
  • reduction in inappropriate prescribing and referrals to secondary care

Following successful bids for Pathway Transformation Funding, Bath and North East Somerset, Swindon and Wiltshire CCG (BSW CCG) and Gloucestershire CCG were awarded funding to implement FeNO testing and are currently piloting the approach using a number of different models.

In BSW, FeNO testing is being made available to all GP practices in the region and is being supported by locality clinical leads in each area.  Many of these practices are currently using a mobile model and sharing FeNO devices to ensure equity of access for their patients, with some areas trialling a fixed hub model, with a view to comparing the two approaches in a project evaluation.

Nicci Mawer, Nurse at Combe Down Surgery said:

“We have been using the FeNO machine in my practice for a couple of months now.  I started using it with a degree of scepticism but can honestly say it is a valuable tool for aiding the diagnosis of asthma as well as monitoring existing patients who are uncontrolled and needing potential treatment change or can be informed that their current treatment is working.  It is easy to use and clean and can be done in a 10 minute appointment if you are only performing FeNO.  Patients find holding and breathing into the device quick and easy and it proves to patients that there is inflammation that needs dealing with.”

Gloucestershire received funding to introduce FeNO testing in 19 practices across one locality and are implementing this with a hub and spoke model, with staff attending training at a hospital clinic with a Senior Nurse Practitioner before receiving a device to use in their own practice. This has resulted in the CCG funding a wider rollout of FeNO testing across their whole region, with another 41 devices about to be deployed.

Funding and project support available

Whilst providing project management support to the existing FeNO roll out, the West of England AHSN is also able to extend this offer to individual Primary Care Networks looking to implement FeNO testing. The AHSN can co-ordinate training and signposting to educational resources, facilitate clinical pathway design and liaise with analysts around data collection. To promote the benefits of FeNO testing more widely, webinars have been delivered throughout December and January with 63 attendees from across the West of England.

The South West Clinical Network is really pleased to support this initiative as outlined by Adrienne Rogers, Clinical Network Manager:

“We’re delighted to support the extension of FeNO use across the South West Region by the provision of additional FeNO devices to map onto gaps identified from our Primary Care Respiratory Champion programme, plus thousands of mouthpieces to enable greater delivery for the region’s AHSN -supported FeNO projects in primary care.”

FeNO offers an opportunity to support both the early and accurate diagnosis of asthma, as well as monitoring compliance and effectiveness of asthma management. This will all help our regional systems to deliver on their commitment to the NHS Long Term Plan, and support our respiratory populations to access the right care at the right time.”

You can find out more about FeNO testing here.

If you’re interested in implementing FeNO  in your practice and would like to find out more about accessing funding and support please contact Senior Project Manager, Charlotte Hallett.

Find out more about the West of England’s work to identify gaps and priorities and signpost proven treatments and diagnostics through programmes such as Rapid Uptake Products and Med Tech Funding Mandate.

 

 

 

Working collaboratively to improve patient safety during COVID-19

Since mid-November, the West of England AHSN has been supporting our three STP systems with the rapid implementation of the COVID Oximetry @home service (a step up pathway) to help detect the early signs of deterioration in patients with confirmed or suspected COVID-19. More recently, since mid-January, COVID Virtual Wards (‘step-down’ pathways to help enable people in hospital with COVID-related illness to return home safely as soon as possible) are also being rolled out across the region.

By working collaboratively, over 2000 patients (figure updated May 2021) have now been supported by these programmes across the region.

Both of the pathways feature enhanced monitoring for patients with a confirmed COVID case – pulse oximeters are used by the patient to identify ‘silent hypoxia’ (a reduction in oxygen levels in the blood with no other obvious clinical signs). These services built on learning from the first wave of the COVID-19 pandemic and make use of clear escalation pathways based on the person’s oxygen saturation levels in the blood (which are known as sats).

The West of England AHSN has provided a supportive role to our three STP systems, helping drive collaboration within, and across, each region with over 1500 patients having been supported across the step up service (COVID Oximetry @home) and over 100 patients on the step down service (COVID Virtual Ward) thus far.

Crucially for patient safety, these services were demonstrated to reduce mortality, reduce inappropriate hospital admissions (findings also suggest monitoring sats allows patients to be admitted to hospital before they have severely deteriorated), reduce the length of hospital admissions and escalation to intensive care wards.

Both COVID pathways have been fast-paced implementations of new services, largely from a standing start, with most systems in our region rapidly launching the pathways within a few weeks of the publication of national guidance from NHS England.

Hein Le Roux, Joint Clinical Lead for Gloucestershire CO@H, also Clinical Lead West of England AHSN, and GP at Churchdown, said:

“The COVID Oximetry @Home service has had a real impact on my patients who have developed COVID. In Gloucestershire, over 1100 patients have been referred to the service and for the majority it has provided reassurance that they have not developed the potentially fatal silent hypoxia. For the few people who did deteriorate, we were able to identify them early and prioritise their care with steroids and oxygen in the hospital setting.

This has meant they were less unwell prior to receiving treatment and have thus recovered more quickly. It has also shown that by working together as a care system between primary care, the COVID Oximetry @Home service, South Western Ambulance Service NHS Foundation Trust and our acute colleagues, we have improved patient care”.

Michelle Reader, Chief Operating Officer from Medvivo said:

“The Medvivo-provided oximetry monitoring services are a testament to the collaborative and system-wide approach that was taken across BaNES, Swindon and Wiltshire (BSW). Once we’d offered to provide the service for the region we felt really supported by colleagues in commissioning, primary care, secondary care, community services and the AHSN. This allowed these services to be established very quickly, enabling us to provide valuable supportive services to the people of BSW.

The sharing of learning from other areas was really important. I’ve never been part of such a rapid system-wide collaboration, and there was a real ‘can do attitude’ from all involved. It’s been a learning process and we continue to learn and develop the service. The feedback from the patients has been fantastic – this makes all the efforts worthwhile.”

To find out more about COVID Oximetry @home and COVID Virtual Wards, including implementation packs and recorded webinars, please visit our dedicated COVID-19 webpages.

The below case study demonstrates the impact of the COVID Oximetry @home pathway through the story of one patient who we will call John*:

  • Day 1 – John is a 57 year old gentlemen who has developed cough and fever.
  • Day 2 – John takes a COVID test
  • Day 3 – John receives a positive COVID test result. John’s GP contacts him and he is placed in ‘at risk group’ for silent hypoxia & deterioration. John is referred to the COVID Oximetry @Home (step up care pathway) and provided with pulse oximeter.
  • Day 4 – John receives advice on how to use the service for daily monitoring of blood oxygen saturations through a digital monitoring platform. John’s sats are recorded at 95%.
  • Day 7 – John’s sats are now 91% (this is now in the parameter of silent hypoxia). John is contacted by the service provider where he advises he is feeling ‘okay’. John’s advised to call 999 urgently for hospital assessment and possible treatment.
  • Day 7 to 10 – John is admitted to hospital and given dexamethasone and oxygen. John’s sats gradually improve over the next three days.
  • Day 10 – John is discharged home after four days in hospital. John is now monitored on the COVID Virtual Ward (step down pathway).
  • Day 13 – John has made steady progress and is discharged from the COVID Virtual Ward service and sign posted to Long-COVID pathway & given safety netting information.

Without the COVID Oximetry @home service and use of a pulse oximeter, John may not have known he was significantly unwell and could have required more extensive hospital treatment, or potentially even died. These services have not only a positive impact for the patient but the positive impacts are seen across primary and secondary care.

*John is not the patient’s real name.

Flu resources launched: People with a learning disability are at greater risk of developing serious illness

The national flu campaign to encourage uptake of the free flu vaccination, particularly amongst at risk groups, has launched.

Individuals with a learning disability are identified as an ‘at risk’ group and are therefore entitled to a free flu vaccine. As are their carers, whether that is a family member or paid support staff who care for the individual day-to-day.

As such, the West of England AHSN and our Learning Disabilities Collaborative will be continuing to share advice and raise awareness of the importance of individuals with a learning disability, their families and carers, getting the flu vaccination throughout winter.

On behalf of the NHS, Misfits Theatre Company have created a great video which tackles the misinformation surrounding the flu vaccination head on and urges people with learning disabilities and their carers (family member or support worker) to not delay in getting their free flu vaccine.

You can watch the video here.

People who have a learning disability can be more susceptible to the effects of flu and are therefore at increased risk of developing complications such as bronchitis or pneumonia. As the NHS emerges from the covid pandemic, anyone with a learning disability is encouraged to get their free vaccination and annual health check to help stay well this winter.

Carers of anyone with a learning disability are also entitled to the free vaccination. All carers (family member or support worker) are urged to ensure they are registered at their local GP practice as a carer of someone with a learning disability. Individuals should also be on their GP Learning Disability Register to access the very best care.

Now is the time that GP practices and community pharmacies are carrying out vaccinations for those at risk. The vaccine offers the best level of protection from the flu virus, and it’s important to have the vaccine every year, especially as the flu virus strain changes every year. Anyone who is defined as being in an ‘at risk’ group should contact their surgery and arrange an appointment to have the vaccine.

Having the vaccine sooner provides the individual with protection over a longer period of time; it also helps reduce the chances of spreading the virus to family and friends.

Watch this NHS England and Improvement video where Camilla, who has a learning disability, talks about getting her flu jab. 

Hannah Little, our Patient Safety Improvement Lead and Senior Project Manager said:

“Flu is a very unpleasant illness. The symptoms can be miserable for many of us, but it can lead to more serious complications for those who fall within certain clinical ‘at risk’ groups. Some people with a learning disability can be more susceptible to flu and can go on to develop more serious complications like pneumonia. Respiratory conditions remain the most significant causes of premature mortality for people with a learning disability where deaths have been reviewed as part of the LeDeR programme.

I’d urge people to make sure they have the vaccination as soon as possible. They should also ask to have their Annual Health Check, which our Learning Disabilities Collaborative discussed at our September 2020 webinar. Carers of anyone with a learning disability should also get the free vaccine from their GP surgery or community pharmacy, the sooner the better to get the best possible protection.”

 

The full pack of winter flu resources for people with learning disabilities and their carers (which includes high resolution resources for social media, communications toolkit and grab pack for professionals) is available on the NHS England and Improvement website.

The flu vaccine is also free for patients in the following at risk groups:
• Those aged 65 years or over (including those becoming age 65 years by 31 March 2021)
• Those aged from 6 months to less than 65 years of age with a serious medical condition such as:
• Chronic (long term) respiratory disease, such as severe asthma, chronic obstructive pulmonary disease (COPD) or bronchitis.
• Chronic heart disease – (such as heart failure).
• Chronic kidney disease (at stages three, four or five).
• Chronic liver disease.
• Chronic neurological disease such as Parkinson’s disease or motor neurone disease
• Diabetes
• Splenic dysfunction
• Reduced immune system due to disease (such as HIV/AIDS) or treatment (such as cancer treatment)
• Morbidly obese (defined as BMI of 40 and above)
• All pregnant women (including those women who become pregnant during the flu season)
• All children aged 2 and 3 years

• All children in school years R through to year 5
• People living in long-stay residential care homes, or other long-stay care facilities where rapid spread is likely to follow the introduction of infection and cause high morbidity and mortality.
• People who are in receipt of a carer’s allowance, or those who are the main carer of an older or disabled person whose welfare may be at risk if the carer falls ill
• Consideration should also be given to the vaccination of household contacts of immunocompromised individuals, specifically individuals who expect to share living accommodation on most days over the winter and therefore for whom continuing close contact is unavoidable

The Primary Care Collaborative

The collaborative is no longer active, but you may find the below resources useful. Please note the information on this webpage was correct at the time of publication:

In May 2016 we launch our first Primary Care Collaborative. with up to 20 primary care practices from across our seven clinical commissioning groups (CCG) set to join the first cohort. This collaborative will form part of the wider West of England Patient Safety Collaborative.

The initial aim of the Primary Care Collaborative will be to promote a safety culture in the primary care setting through the use of incident reporting, leading to better outcomes for patients. It will also increase awareness amongst practice teams of the patient safety agenda, while promoting an open and honest culture.

Additional benefits for practices will include improving preparation for Care Quality Commission (CQC) inspections and the revalidation and appraisal process for all staff.

Each practice will complete a patient safety culture survey and we will support practices with tools and training in Quality Improvement (QI) methodology, enabling the identification of opportunities to improve patient safety. Practices in the collaborative will come together at four learning and sharing events during 2016/17.

Alison Moon, Transformation & Quality Director for Bristol Clinical Commissioning Group (CCG), says:

“It is really positive working with the AHSN on the primary care programme. There’s a combination of energised joint working, a structured improvement approach and the sharing of best practice and experiences, which gives us a really good chance of achieving our shared objectives on patient safety.”

Contact

For more information on the Primary Care Collaborative, please contact Kevin Hunter at kevin.hunter@weahsn.net.