Post on 12-Jan-2016
Respiratory Service FrameworkAsthma and COPD Care (Nursing)
Project Learning and Development Strategy
LEARNING AND DEVELOPMENT STRATEGY
S
LEARNING AND DEVELOPMENT STRATEGY
S
Service frameworksService frameworks are defined as being measurable, are defined as being measurable, evidence–based standards which are the product of a process evidence–based standards which are the product of a process of engagement with HSC staff, service users and the public. of engagement with HSC staff, service users and the public.
Each Framework will follow the individual’s journey, from Each Framework will follow the individual’s journey, from prevention through to end-of-life care, taking account of all prevention through to end-of-life care, taking account of all
aspects of health and social care providing an opportunity to aspects of health and social care providing an opportunity to promote evidence-informed practice with a focus on safe and promote evidence-informed practice with a focus on safe and
effective care. effective care. Template for the Development of Service Frameworks for Template for the Development of Service Frameworks for
Health and Social CareHealth and Social Care Department of Health, Social Services Department of Health, Social Services and Public Safety, 2007. and Public Safety, 2007.
What is a Service Framework? Explicit standards on prevention, treatment and care “Quality requirements” supporting the standards
Specific timeframe - 3-5 years and revision process
Capable of measurement/comparative data
Linked to the HSC quality standards and other policy, documents and guidance
Applicable to both adults and children
Follow a life cycle approach
Developed in collaboration with the HSC and public.
Patient/client Pathway Template
Prevention / PromotionProtection /Lifestyle
Treatment
Ongoing Care / Chronic DiseaseManagement
End of Life Care / Palliative Care
Assessment & Diagnosis
Overarching Standard 6.1.1All people suspected of having COPD should have accurate assessment, diagnosis and management in Primary Care.
RationaleCOPD should be prevented where possible, but, as a minimum, disease progression should be slowed down or avoided by early diagnosis and optimal management in keeping with the most up to date evidence based guidelines.Evidence National Institute for Clinical Excellence (2004) Management of chronic obstructive pulmonary disease in adults in primary and secondary care. National Institute of Clinical Excellence: Londonhttp://thorax.bmj.com/content/vol59/suppl_1/Strategic Framework for Respiratory Conditions (N. Ireland), 2006. http://www.dhsspsni.gov.uk/pcd_-_respiratory_framework.pdf
Responsibility for delivery / implementationHSC TrustsPrimary Care
Quality Dimension 1.All patients older than 35 years, with past/present smoking history, and presenting with exertional breathlessness, chronic cough, regular sputum production, frequent winter bronchitis or wheeze should have spirometry performed. 2.All patients with a diagnosis of COPD should have an assessment and review according to NICE guidelines 3.All patients suspected of or diagnosed with COPD should have their smoking history recorded and be given appropriate advice about smoking cessation and specialist smoking cessation services.
Performance Indicator Data Source Expected Performance Level
Date to be achieved by
Percentage of patients with COPD who smoke, who have had appropriate smoking advice
DES Data setAudit of GP records
60%80%90%
March 2010March 2011March 2012
Percentage of patients with COPD who are assessed, diagnosed and managed according to NICE Guidelines in primary care.
DES datasetRolling audit of GP records
60%80%90%
March 2010March 2011March 2012
How will they be assessed?
• Service Audits
• Patient Registers
• QOF data sets
• DES data sets
• PAS
• Evidence collected by organisations to support achievement
Current Work
Cardiovascular DiseaseCardiovascular Disease
Respiratory WellbeingRespiratory Wellbeing
CancerCancer
Mental HealthMental Health
Learning DisabilityLearning Disability
April 2008April 2008
May/ JuneMay/ June20082008
July 2008July 2008
The Future of COPD Nursing Care
The RSF Standards
LEARNING AND DEVELOPMENT STRATEGY
S
LEARNING AND DEVELOPMENT STRATEGY
S
CommunicationCommunication
Patient EducationPatient Education
Location of CareLocation of Care
Health TechnologyHealth Technology
Multidisciplinary WorkingMultidisciplinary Working
Prevention / PromotionProtection /Lifestyle
Modifiable RisksModifiable Risks
Smoking Cessation/ PreventionSmoking Cessation/ Prevention – Specific Targets – Specific Targets
Smoking ReductionSmoking Reduction
Lifestyle assessmentLifestyle assessment
Physical ActivityPhysical Activity
Planned ProgrammesPlanned Programmes
EducationEducation – Medication compliance and efficacy – Medication compliance and efficacy
Patient PartnershipPatient Partnership
Negotiating a Negotiating a plan of care plan of care and lifestyle and lifestyle adjustmentsadjustments
Assessment & Diagnosis
History Taking History Taking
Airflow Limitation Airflow Limitation – SPIROMETRY – SPIROMETRY
Accurate, interpreted Accurate, interpreted
ScreeningScreening – Symptomatic smokers – Symptomatic smokers
Registers Registers
Treatment
Self Management Self Management – Face-to-face care planning– Face-to-face care planning
Written copyWritten copy
One core written planOne core written plan
Acute ExacerbationAcute Exacerbation – Early Supported Discharge – Early Supported Discharge
Resp. PhysicianResp. Physician
Emergency Oxygen Emergency Oxygen – Alert cards– Alert cards
BTS GuidelinesBTS Guidelines
NIV NIV – Management of NIV– Management of NIV
Case ManagementCase Management – Expertise in Co-morbidities – Expertise in Co-morbidities
Ongoing Care / Chronic DiseaseManagement
TelemonitoringTelemonitoring – 50k patients in next 3 years – 50k patients in next 3 years
Pulmonary RehabilitationPulmonary Rehabilitation – MRC 3+ offered referral – MRC 3+ offered referral
Monitoring uptakeMonitoring uptake
Programme Development and accessProgramme Development and access
Nebuliser Therapy Nebuliser Therapy – Assessment for– Assessment for
Equipment – Compressor/ O2Equipment – Compressor/ O2
LTOT LTOT – Adherence to Assessment Criteria– Adherence to Assessment Criteria
Ongoing MonitoringOngoing Monitoring – Annual Review/ ½ yearly – Annual Review/ ½ yearly
Case ManagementCase Management
End of Life Care / Palliative Care
Key Worker Key Worker – Core Palliative Care Competencies– Core Palliative Care Competencies
Early Needs AssessmentEarly Needs Assessment – MRC 5 – MRC 5
Trigger QuestionsTrigger Questions
Patient ChoicePatient Choice
Supportive and Palliative Care RegisterSupportive and Palliative Care Register
Breaking Bad News Breaking Bad News - Communication- Communication
The Future of Asthma Nursing Care
The RSF Standards
LEARNING AND DEVELOPMENT STRATEGY
S
LEARNING AND DEVELOPMENT STRATEGY
S
CommunicationCommunication
Patient EducationPatient Education
Location of CareLocation of Care
Health TechnologyHealth Technology
Multidisciplinary WorkingMultidisciplinary Working
Modifiable RisksModifiable Risks
Smoking Cessation/ PreventionSmoking Cessation/ Prevention – Specific Targets – Specific Targets
Maternal Health/ Parental Health Maternal Health/ Parental Health
Lifestyle assessmentLifestyle assessment – Allergy Triggers – Allergy Triggers
Physical ActivityPhysical Activity
EducationEducation - Medication compliance and efficacy - Medication compliance and efficacy Patient PartnershipPatient Partnership
Health Inequalities Health Inequalities – Immigrant Populations– Immigrant Populations
Electoral WardsElectoral Wards
Prevention / PromotionProtection /Lifestyle
Assessment & Diagnosis
History Taking History Taking - One airway (allergic Rhinitis) - One airway (allergic Rhinitis) allergy testingallergy testing Diagnostic Therapy Trial Diagnostic Therapy Trial
Airflow Limitation Airflow Limitation – SPIROMETRY – SPIROMETRY Accurate, interpretedAccurate, interpreted
Treatment
Self managementSelf management – Face-to-face care planning– Face-to-face care planning Written copyWritten copy One core written planOne core written planAnaphylaxis ManagementAnaphylaxis Management – Register – Register Allergy expertiseAllergy expertiseAcute Exacerbation Acute Exacerbation – Treatment as per Guidelines– Treatment as per Guidelines
Review and Follow-upReview and Follow-up – Admission – Admission
A&EA&E
Non-admissionNon-admission
Ongoing Care / Chronic DiseaseManagement
ReviewReview – – Frequent admissionsFrequent admissions
Early Follow upEarly Follow up
Appropriate ReferralAppropriate Referral – Difficult to Control Asthma – Difficult to Control Asthma
Alert CardsAlert Cards – Education – Education
Inhaler TechniqueInhaler Technique
Allergy HistoryAllergy History - Testing - Testing