Improving asthma diagnosis and patient care in Bristol, North Somerset and South Gloucestershire

Over the past year, the West of England AHSN has been supporting six Primary Care Networks (PCNs) in Bristol, North Somerset and South Gloucestershire (BNSSG) to implement FeNO testing, which supports faster and more accurate diagnosis of asthma. 27 practices are now offering the service, with 775 tests performed to December 2022.

The project forms part of the 2022/23 Rapid Uptake Products (RUP) programme delivered locally by AHSNs. More work across BNSSG Integrated Care Board (ICB) is planned between now and March 2023, when the programme closes.

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

Funding for FeNO testing devices and consumables has come from several different routes, including PCNs and practices purchasing their own devices.  Alongside this, the South West Respiratory Clinical Network provided financial support to PCNs with Respiratory Champions. The ICB has also recently allocated funding to each PCN, supported by BNSSG Respiratory Board as an innovate partnership.

Survey responses (33 respondents) indicate that patients are so far benefitting from more local access to FeNO testing with:

  • 93% of patients travelling less than 3 miles for an appointment
  • 75% of patients taking less than 10 minutes to travel to an appointment
  • 69% of patients waiting less than 2 weeks for an appointment

Amongst others, the AHSN has worked closely with Swift PCN, based in South Bristol, which comprises eight practices with a population of 75,000.

Lesley Ward, GP and Clinical Director, Swift PCN said:

“We were supported with a full education and evaluation package and the AHSN also helped organise virtual education sessions to support with the diagnosis and management of asthma which was invaluable.  We have been using FeNO testing in practices since April 2022 and have three machines that are shared on a rotational basis.  To date we have undertaken over 250 tests and nurses have found it a real benefit in ‘on the spot’ diagnosis and management of asthma.

FeNO testing is quick and easy to use and patients like the instant feedback and can see the benefits of compliance or changes in treatment.  We are hoping that over time we will see the benefits in reduction in prescription steroids, hospital admissions and a reduction in the use of short acting beta agonist inhalers.  Thank you to the West of England AHSN for their time and support.”

The West of England AHSN is providing project management support and meeting with project teams regularly to review progress, challenges and lessons learned.  A virtual FeNO community of practice has also been established to encourage staff to network and share their experiences – these sessions are open to all practices in BNSSG. Resources developed to support the project include implementation checklists, staff and patient experience surveys and data infographics.  Webinars and device-specific training sessions have been delivered, with 55 attendees across BNSSG.

Charlotte Hallett, Senior Project Manager, West of England AHSN said:

“It’s really positive to see the spread of FeNO testing across the system and have the opportunity to work with clinicians that are passionate about improving respiratory care.  Their engagement has driven the project in each PCN, enabling them to develop models of offering FeNO testing that work best for them.”

Geeta Iyer, Clinical Lead for Primary Care Development, BNSSG ICB said:

“BNSSG ICB are working closely with the AHSN, One Care and the General Practice Collaborative Board by augmenting this work with further funding and supporting other PCNs with obtaining FeNO machines. These PCNs will also have access to learning via the AHSN and a Community of Practice. This forms an important part of the recovery of services after the pandemic and BNSSG ICB is also working with the Avon Local Medical Committee around the restart of spirometry in practices.”

Launching our project to improve non-invasive ventilation

In December 2022, 24 colleagues from six regional acute hospital trusts and the West of England AHSN came together to launch a new collaborative project focused on improving patient outcomes from non-invasive ventilation (NIV).

Watch our introductory video on Vimeo:

Acute NIV is an evidence based, clinically effective and lifesaving treatment used to manage patients presenting with specific conditions in Type II (hypercapnic) respiratory failure. In 2019, a British Thoracic Society (BTS) audit on adult NIV care reported the inpatient mortality rate was 26%. This was an improvement on previous audits in 2010 and 2013, however mortality rates remained higher than in other countries.

This unique project aims to reduce mortality rates to 10% or lower for patients who require acute NIV for Type II respiratory failure. This will be achieved through a collaborative approach which implements a regional standardised care bundle.

The five bundle elements are:

  • Appropriate case selection – NIV is only recommended in acute Type 2 Respiratory Failure where it is proven to be effective.
  • Treatment Escalation Plan in place – ReSPECT form to be completed with specific reference to suitability for invasive ventilation or NIV as ceiling of treatment.
  • NIV to be started within 60 minutes of decision to treat.
  • Inspiratory pressure of 20cmH₂O to be achieved within 60 minutes.
  • Arterial or capillary blood gas to be repeated within two hours of starting NIV.

Read about the drivers informing our NIV project in a blog from Dr Rebecca Mason.

Dr Rebecca Mason, project Clinical Lead and Respiratory Consultant at the Royal United Hospital, Bath said:

“This new pan-regional project seeks to improve NIV outcomes for patients through the implementation of a regional standardised care bundle, based on the BTS quality standards. In addition, we aim to improve staff knowledge, and competence in use of NIV, along with patient experience through enhanced communication and development of teaching materials”.

Dr Mark Juniper, Medical Director at the West of England AHSN and Respiratory Consultant, Great Western Hospitals, Swindon said:

“It was great to host this event. The energy in the room was invigorating and the enthusiasm of the teams to participate was clear. Getting the Trusts together and designing this project as a group was a really important step forwards.”

An evaluation exploring this project will be completed in Spring 2024. It is hoped this will lead to adoption and spread of the care bundle beyond the West of England.

To find out more, please visit our NIV care webpage, follow #NIVcare on Twitter or contact Senior Project Manager, Megan Kirbyshire.

Improving patient outcomes: non-invasive ventilation

In this blog, project Clinical Lead and Respiratory Consultant at the Royal United Hospital Bath, Dr Rebecca Mason, looks forward to the launch of a new West of England collaborative to reduce mortality following non-invasive ventilation (NIV). A design and launch event is being held on 9 December. Here Rebecca explains more…

Acute NIV is an evidence based, clinically effective and lifesaving treatment used to manage patients presenting with specific conditions in type 2 (hypercapnic) respiratory failure.  In 2000 a research study showed that effective NIV use reduced mortality in type 2 respiratory failure from 20 to 10% but by 2013 the British Thoracic Society (BTS) NIV audit had recorded that mortality rates had risen to 34% and change was needed.

These results prompted a 2017 National Confidential Enquiry into Patient Outcome and Death (NCEPOD) and ultimately the report entitled ‘Inspiring change’. This report focussed on patient selection and the standard of NIV care delivered in hospital trusts across the country and the results made for stark reading. In 2019, a BTS audit on adult NIV care reported the inpatient mortality rate was now 26%. This was an improvement on previous audits however mortality rates remained higher than in other countries.

The ‘Inspiring change’ report galvanized a group of South West Respiratory doctors, nurses and physiotherapists with a special interest in NIV to join together in October 2018 to establish a Quality Improvement (QI) network with the aim to drive change within their own trusts and across the region. Although enthusiastic and full of ideas, without the structure and support of a full QI team, and then with the arrival of the Covid pandemic, the group’s work halted.

However, I am extremely excited that with the fabulous support, structure and guidance of the West of England AHSN, and the enthusiasm of many NIV physicians, nurses, physiotherapists and AHPs across the South West, we have been able to reinvigorate this project.

This new pan-regional QI project will seek to improve NIV outcomes for patients through the implementation of a regional standardised care bundle, based on the BTS quality standards. In addition, we aim to improve staff knowledge, and competence in use of NIV, along with patient experience through enhanced communication and development of teaching materials.

I am really looking forward to working alongside my respiratory colleagues across the region and with the expert support of the AHSN to deliver this important and exciting QI project.  With the hosting of our design and launch event on 9 December we’ll be stepping up activity, and as a first step gathering baseline data and agreeing our implementation plan.

Patients in Bath and North East Somerset, Swindon and Wiltshire receiving faster and more reliable asthma diagnoses

A new evaluation has found more patients in Bath and North East Somerset, Swindon and Wiltshire (BSW) are receiving faster and more reliable diagnoses of asthma thanks to an ambitious project designed to ensure adoption and spread of proven innovative products.  A system wide project, led by the West of England AHSN, took place between September 2021 and June 2022, to rollout FeNO devices in a mobile model across the region. The project resulted in 1,896 patients receiving a FeNO test.

FeNO testing is part of the Rapid Uptake Products (RUP) programme to increase uptake of NICE approved products.  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

Prior to this project, FeNO testing was not available in primary care settings in BSW and therefore wasn’t always easily accessible to patients.  The project aimed to provide access to FeNO testing in every practice in the region, using a mobile model with devices shared between and moving around multiple sites.  Several Primary Care Networks (PCNs) procured additional devices that were used in a fixed hub model to better meet the needs of their patients and hubs are being considered further following the evaluation.  The project evaluation has found 75% of practices are now offering FeNO testing, which has improved access and reduced travel for patients, with over 80% of patients travelling less than 3 miles for an appointment.  Between September 2021 and June 2022, 1,896 patients were reviewed, with 263 receiving a diagnosis of asthma.

The West of England AHSN supported the application for Pathway Transformation Funding to enable the purchase of FeNO devices and mouthpieces, in addition to backfill for local clinical leads to champion the project in their area and provide support to practice staff.  Bath & North East Somerset Enhanced Medical Services (BEMS) led on the co-ordination of resources and transport in their area.  Project management support was provided by the AHSN to monitor the project timeline, collect and analyse data and record risks and issues.  A new pathway and surveys were co-created and regularly reviewed to measure and continuously improve staff and patient experience of the new service.  As part of the AHSN’s regional FeNO Programme, it co-ordinated the delivery of FeNO testing education webinars that were open to healthcare professionals across the West of England to 95 delegates.

“The FeNO project has been hugely successful and highly appreciated by the staff and patients in primary care.  There has been loads of learning on the way supported by truly dedicated and passionate clinicians.”

Louise Abson, GP Partner Widcombe Surgery and BSW ICS Clinical Lead Planned Care

“It has been great to work collaboratively with the Integrated Care Board, BEMS and so many clinicians on this project.  Implementing FeNO testing in over 60 practices has been such an achievement and wouldn’t have been possible without the support and hard work of primary care staff.  The data from this evaluation demonstrates how patients are benefitting from improved access to FeNO testing.”

Charlotte Hallett, Senior Project Manager, West of England AHSN

Regional neonatal units celebrate highest delayed cord clamping rates in England

Maternity and neonatal (MatNeo) units across the South West are celebrating achieving the highest delayed cord clamping rates in 2020 in England, as measured by the National Neonatal Audit Programme (NNAP). On average, units across the South West also achieved the third lowest rates of mortality to discharge, the second lowest rates of necrotising enterocolitis, alongside the fourth highest administration levels of magnesium sulphate (MgSO4) across England.

The NNAP assesses whether babies admitted to neonatal units in England, Scotland and Wales receive consistent high-quality care, and identify areas for quality improvement. The NNAP’s most recent audit shows delayed cord clamping was at its highest level in units in the South West. More than a 20% difference was illustrated between South West units (at 60.6%) and the second highest performing region (39%). Evidence shows that avoiding immediate cord clamping reduces death in preterm babies by nearly a third.

These results follow intensive activity across the region to drive adoption and spread of a range of neonatal interventions, including delayed cord clamping and MgSO4, through a unique care bundle known as PERIPrem (Perinatal Excellence to Reduce Injury in Premature Birth).

Implementing PERIPrem

Launched in April 2020, PERIPrem is a perinatal bundle designed to improve the outcomes for babies born before 34 weeks. The West of England Academic Health Science Network (AHSN) is delivering PERIPrem in partnership with South West AHSN and South West Neonatal Network. The bundle consists of eleven interventions that demonstrate a significant impact on brain injury and mortality rates amongst babies born prematurely.

The bundle was the first of its kind, and co-created by clinicians, MatNeo teams and parents. Since April 2021 PERIPrem has continued to be delivered across the region as part of the NHS Improvement Maternal and Neonatal Safety Improvement Programme. A number of NHS Trusts across England are now implementing care bundles based on the PERIPrem model.

Achieving results

By providing frequent share and learns, 360 simulation videos, toolkits and quality improvement coaching to facilitate the spread of knowledge and best practice, PERIPrem increased confidence in delayed cord clamping. This incudes when babies are extremely premature, require resuscitation at delivery or are part of a twin delivery. Free cord clamping resources can be accessed on the PERIPrem webpages.

The NNAP explains that necrotising enterocolitis (NEC) “is a devastating illness which can follow preterm birth. Bowel inflammation prevents milk feeding and surgery may be needed. Babies who develop NEC typically stay in hospital for a long time. Rates of mortality in babies with NEC are high, at over 20%. Babies who survive NEC can have developmental as well as long-term feeding and bowel problems”. Units in the South West achieved the second lowest levels of NEC (at 4.7%) in England. Rates of NEC are directly influenced by two PERIPrem bundle elements: probiotics and early breast milk.

Learning from PReCePT

Building on the progress made nationally through the AHSN Network PReCePT programme (which was developed in the West of England region), the administration of MgSO4 remained a core intervention of the PERIPrem care bundle.  The administration of MgSO4 to all eligible women in England during preterm labour (less than 30 weeks) reduces the incidence of cerebral palsy. Magnesium sulphate costs from just £1 per dose. Free MgSO4 resources can be accessed on the PERIPrem website.

The focus across a broad range of interventions known to reduce mortality led to the region achieving the third lowest rate of pre-term mortality to discharge home in England (at 5.6%).

Natasha Swinscoe, Chief Executive of the West of England AHSN and Patient Safety Lead for the AHSN Network said:

“To December 2021 over 1090 babies have benefited from the PERIPrem bundle. It is a testament to the hard work of all South West MatNeo staff, and everyone who contributed to our PERIPrem project, that the South West region has the highest levels of delayed cord clamping alongside multiple other positive results which crucially include the third lowest level of pre-term mortality in England.

Launching PERIPrem during a pandemic, and at a time of extreme pressure on the NHS, wasn’t easy but these results illustrate the dedication and enthusiasm to improve the safety and life chances of the most vulnerable babies and their mothers”.

Sarah Bates, Consultant Paediatrician & Neonatologist at Great Western Hospitals NHS Foundation Trust and PERIPrem Neonatal Operational Clinical Lead said:

“Working as part of the PERIPrem team has been an inspiring experience. The results of the NNAP illustrate the impact the bundle is having – it’s particularly striking to see average delayed cord clamping rates in our units at least 21% higher than in other regions. In all my years looking at similar data I don’t think I’ve ever seen such a wide range.

Knowing that PERIPrem has longevity locally and is now being adopted in other parts of England, illustrates the potential it has to change the lives of pre-term babies – that is something everyone who contributed to the project can be very proud of”.

At the 2021 HSJ Patient Safety Awards, PERIPrem was highly commended in the category of Patient Safety Pilot of the Year. PERIPrem was also shortlisted for Provider Collaboration of the Year at the HSJ Awards in 2021.

Read more in our PERIPrem case study.

The full NNAP report and data can be accessed here.

Book now: accredited quality improvement for pharmacy teams launches

The West of England Academy are hosting a new series of five free-to-attend interactive online workshops each Tuesday evening from 1 March. This is the first series of introductory QI workshops tailored specifically by the AHSN for pharmacy teams.

Attendees will gain a basic understanding and practical knowledge of applying Quality Improvement (QI) techniques to real-world pharmacy challenges in healthcare and innovation.

Modelled on our hugely successful QI Summer and Winter Series, this five-week course, held over 90-minutes each Tuesday from 18:30pm can be joined as single sessions or a series.

“This was a fantastic introduction to QI, which is what I needed. I loved how things were explained so clearly and the session was interactive. It really helped my understanding, and I got a lot from the session.”

The accredited workshops have been developed, and will be delivered by, the West of England Academy and Medicines teams alongside guest speakers. Topics include introductions to process mapping, data management and the basics for change management. The series will earn attendees six CPD hours.

Attendees will see how QI can lead to better outcomes for their teams, patients and organisation, gain confidence in applying QI and have time to network with pharmacy colleagues from across the region.

“I am newly appointed as a QI manager so have used all the tools and techniques in my daily work and shared this with other colleagues and teams.”

Attendees can be in any role and/or grade within their pharmacy, and clinical or administration.

Our academy works hard to welcome attendees from a broad range of backgrounds creating a safe and open environment for learning and sharing ideas.

“The practical skills and frameworks are fantastic and such a great way to engage and inspire others. They will definitely help identify why a challenge is a challenge and instigate conversations about how we can overcome and/or improve processes.”

Find out more about the series and book here.

The West of England Academy offers a wide range of free events and resources to healthcare professionals and innovators across the region. To find out more, visit our Academy pages or email

QI in pharmacy? It’s a brave new world.

In a new joint blog from Senior Project Manager, Chris Learoyd and Ola Howell, Clinical Pharmacy Lead at the West of England AHSN, we explore the value of Quality Improvement (QI) for pharmacy teams, why it hasn’t really been embedded so far and how pharmacy can get involved.

Bringing together mental health teams to improve patient safety and health equity

On 30 November the South of England Mental Health Quality and Patient Safety Improvement Collaborative (known as the MHC) held an all-day learning event for mental health teams across the South of England. The event – held online – was an opportunity for sharing learning and networking, which has been particularly challenging for large geographic collaboratives during the pandemic.

Hosted by the West of England AHSN, the collaborative was created in partnership with the South West AHSN, and now includes Kent, Surrey and Sussex AHSN, Oxford AHSN, and Wessex AHSN alongside 16 mental health trusts across the south of the country. The MHC aims to improve the quality and safety of services for people with mental health conditions.

MHC learning events enable collaboration across the mental health sector in order to foster quality improvement (QI) approaches to patient safety, drive health equity and review progress against the ambitions of the NHS England Mental Health Patient Safety Improvement Programme (MHSIP), which includes reducing restrictive practice.

The event was chaired by Dr Helen Smith, chair of the MHC and National Clinical Lead for MHSIP with around 90 people joining the event from project teams across the South of England.

The event began with a presentation on experiencing, challenging and addressing inequalities from Chris Lubbe, NHS England. Chris was previously an anti-apartheid activist and acted as Nelson Mandela’s bodyguard. He therefore offered a unique insight into inequalities.

Sussex NHS Foundation Trust then presented on delivering a reducing restrictive project as part of the National Collaborating Centre for Mental Health.

This was followed by a World Café where colleagues from four mental health teams shared their experiences of reducing restrictive practice. This offered a vital opportunity to share learning and consider different approaches.

Presentations then followed from Cornwall NHS Foundation Trust on Reducing Restrictive Practice:  Drivers linked to ‘Seni’s Law’; Creating conditions for learning, and finally QI approaches focused on the live, learn and lead methodology.

Following this event, members of the MHC will continue to meet regularly for QI coaching sessions and all-day learning events.

Feedback from attendees:

“Thank you for such a thought provoking presentation. The take home message for me is to dig deep and speak up and say something”.

“Really good ideas – we will be shamelessly stealing the calm cards in particular! Thank you”.

“What went well? Chris’ presentation to start off the day – an inspirational speaker. Amazing and really highlighted the inequalities within everyday life, including our own services. Also the interactive break out activities”.

If you would like to find out more about the MHC please email

QI in pharmacy? It’s a brave new world.

In this joint blog from Senior Project Manager, Chris Learoyd and Ola Howell, Clinical Pharmacy Lead at the West of England AHSN, we explore the value of Quality Improvement (QI) for pharmacy teams, why it hasn’t really been embedded so far and how pharmacy can get involved, including at our first-ever Pharmacy Showcase on 12 January.

First we hear from Chris…

As the Senior Project Manager for the Medicines Optimisation team at the West of England AHSN, but a former Physiotherapist, I won’t say it was always easy, but I have finally got my head around the wider challenges and issues with safe prescribing of medications.

The numbers are eye watering – circa 237 million medication errors occurring at some point in the medication cycle per year in the NHS in England and 66 million of these considered potentially clinically significant errors. Reducing medication errors can clearly have a significant and immediate effect on patient safety.

We know that as experts in medication management and optimisation, pharmacists and pharmacy technicians are ideally positioned in the healthcare system to improve current processes and reduce avoidable medication-related harm – and that QI approaches are vital to creating lasting change.

As every pharmacy team will know they are being positioned more centrally within healthcare services and have more clinical autonomy. Services such as the Discharge Medicines Service and Community Pharmacy Consultation Service provide a step change to embed pharmacy professionals as an important first point of call for healthcare information rather than traditional settings such as General Practice / Emergency Departments.

Introducing QI

Despite all this, pharmacists often lack the basic tools required to lead on or participate in QI initiatives as they’ve historically not been trained or required to perform QI projects. This is slowly changing, and here at the AHSN we’re working to drive adoption of QI approaches across pharmacy.

Here we’re handing over to Ola who gives details of the reasons for this, the impact and our new offer for pharmacy colleagues….

I’m a clinical pharmacist and over the last 12 years I’ve worked in a community pharmacy (very many of them), a General Practice (very briefly) and a hospital (or three, to be precise). Over those years I have met hundreds of pharmacy technicians and pharmacists determined to ensure their patients got the best (aka safest) care they could.

But I’ve never worked on QI before – what is it?

We are diligent, we are keen, and we are truly brilliant! No need to argue that. The thing that we are not good at is quality improvement. It is not that we don’t do it well, we simply don’t do it enough… And why would we? If you are anything like me and your registration number starts with 20*****, you would, most likely, had never been taught what QI is and how to do it well.

It wasn’t until the last couple of years that I started hearing about the QIPs, the PDSAs and the “driver diagrams”. Maybe I was not expected to know then, but I am now. (And there are masses of free resources on the West of England Academy website to help anyone embarking on QI work – but join our Pharmacy Showcase on 12 January to hear more about free, interactive and tailored support for your team).

Embracing QI to support our profession and wellbeing

Like never before, we are forced to do more and faster with less resources and time. We need to learn how to improve what we do in order to survive. And we need to do it now. The numbers are scary, with every fourth pharmacist reporting feeling ‘very stressed’ at work, mainly due to the increased demand for services and the lack of funding. That is 37% of community teams (up from 17% last year), 20% of hospital pharmacists (up from 10% in 2020) and 14% of GP and PCN pharmacists (up from 5% in 2020)[1]. I anticipate that the figures among pharmacy technicians follow a similar trend. Grim. Burnout alarm bells ringing all over the place.

When I asked around, I wasn’t surprised by the number of suggested solutions to various work problems we come across every day.

Not-a-surprise No. 1: We often know what goes wrong.

Not-a-surprise No. 2: We also often know a solution (or improvement) to the status quo. We sometimes even make that improvement ourselves!

For some reason, however, we rarely document the before and after and so are unable to prove our intervention has worked. “I am not wasting time on the data collection when I have so much to do”, I heard recently from a fellow pharmacist. “But your idea is brilliant! And it saves time, so if other people knew about this, the impact could be huge”, I reply. “Nah, too much effort”, I hear back. I bet this sounds familiar…

Don’t we all roll our eyes when an audit arrives and we need to fill out a spreadsheet, often without pausing for a moment to question what it’s for, and how the results will affect us in the future. Here in lies the answer – capturing our learning and experiences through QI.

Get involved

So come and meet us on the 12 January at our Pharmacy Showcase to hear about the projects our AHSN is involved in, meet the team, network with other pharmacy colleagues and learn more about a free, tailored Pharmacy for QI course coming in spring 2022.

[1] The Pharmaceutical Journal, PJ, November 2021, Vol 307, No 7955;307(7955)::DOI:10.1211/PJ.2021.1.114907

Marking COPD Awareness Month – improving patient safety

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:

  1. Inhaler technique assessed and corrected
  2. Patient or carer has written information & understands their self-management plan
  3. Provision of rescue medication packs
  4. Smokers referred for smoking cessation
  5. Assessment for enrolment in pulmonary rehabilitation
  6. 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.

What’s next

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.

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.

PreciSSIon awarded Quality Improvement Team of the Year

We are delighted to announce that PreciSSIon – a regional collaborative to reduce surgical site infection after elective colorectal surgery – has scooped an award in the Quality Improvement category at The BMJ Awards 2021.

The project – in partnership with Royal United Hospitals Bath NHS Foundation Trust; Gloucestershire Hospitals NHS Foundation Trust; North Bristol NHS Trust; University Hospitals Bristol and Weston NHS Foundation Trust; and Great Western Hospitals NHS Foundation Trust – was awarded the accolade for using original ideas in quality improvement to better outcomes for patients.

Anne Pullyblank, Medical Director, West of England AHSN said:

“This has been a fantastic project to be a part of, and the figures we have been able to achieve at such a challenging time for many in hospitals are absolutely incredible. Combined regional average baseline figures showed surgical site infection (SSI) was 18% pre-November 2019. Implementation of the PreciSSIon bundle elements in all trusts between November 2019 and June 2021 resulted in an amazing almost 50% improvement in SSI rate, leading to a regional average of just 9.5%; a significant improvement in patient experience.

The collaborative element enabled staff and trusts to support each other during the difficulties of the COVID-19 pandemic and engagement was high, with theatre teams in particular being empowered to make a difference. It’s amazing for the hard work of everyone involved to be recognised at the BMJ Awards in the Quality Improvement category.”

Read our Celebrating PreciSSIon article: Reducing SSI rates by 50% with estimated savings of over £500k.

The BMJ Awards ceremony took place on the evening of Wednesday 29 September.

This follows PreciSSIon winning the Perioperative and Surgical Care Initiative of the Year at September’s HSJ Patient Safety Awards. The collaborative project was also shortlisted for the Infection Prevention and Control Award.

Find out more about PreciSSIon.