Sundararaj Manou1 Benjamin Rayner2 Alison Lovatt3 Sundararaj Manou1 Benjamin Rayner2 Alison Lovatt3

Introduction:

Community acquired pneumonia is the fourth leading cause of death in the United Kingdom. British thoracic society recommended the use of ‘COST’ bundle (COST- chest X-ray, Oxygen assessment, Severity score and Treatment) to reduce mortality and length of stay in patients needing admission with Pneumonia. We evaluated the management of Pneumonia within our department and concluded there was considerable heterogeneity and need for educational intervention. We discuss our experience of implementing the educational interventions and their impact on our subsequent performance.

Methods:

Discussions held with the Emergency Department(ED) clinical excellence group to get approval and consensus from senior clinicians to implement the ‘COST’ bundle. Clinicians and nursing staff were given educational sessions using power point, to increase awareness about the bundle and highlight its importance. Re-evaluation of performance showed little improvement. Feedback was sought from the group about the obstacles in implementation and suggestions for improvement. Based on the feedback, periodic re-education and prompts were introduced. Regular face to face teaching sessions were undertaken to increase awareness in the clinical team. To prompt the clinicians, we designed a check-list attached in the notes of all patients who presented with respiratory complaints at triage but the uptake was unsatisfactory as the sheets were lost in patient mobilization. This was therefore re-designed as a sticker on the front page of patient notes. Re-enforcement and encouragement was given in the form of current performance to the group face to face as well as via e-mail.

1 Specialist Registrar EM & Simulation Fellow, Hull Royal Infirmary2 Consultant Emergency Medicine, Hull Royal Infirmary3 Director of Patient Safety, Hull Royal Infirmary

Results:

The Initial audit showed 40% patients with pneumonia presenting to our department received all the components of the bundle. After introduction of the interventions the compliance improved to 90% in 3 months time and this high compliance rate has been sustained over the subsequent three months.

Conclusions:

Evidence-based practice skills and knowledge improve markedly with a targeted education intervention but the change in practise is not usually sustained (1). There are many barriers from evidence to practise -practise environment, prevailing opinion, knowledge and attitude (2). In addition to over-coming external barriers to change, internal motivation can produce permanent change. By using an adult-learning approach in implementing the Bundle rather than a traditional approach of enforcing a guideline and using an experiential learning (3) model we have produced a sustained change.We achieved these by addressing the barriers with the multi-faceted approach- consensus, education, involvement, intention to change, prompt and feedback.

References:

1. A McCluskey ,M Lovarini; Providing education on evidence-based practice improved knowledge but did not change behaviour: a before and after study. BMC Medical Education 2005, 5:402. R Grol, J Grimshaw; From best evidence to best practice: effective implementation ofchange in patients’ care THE LANCET , Vol 362, 2003.3. R Miettinen; The concept of experiential learning and John Dewey ‘s theory of reflective though and action, International Journal of life long Education.Vol. 19, Iss. 1, 2000

Educational intervention to improve Pneumonia care in our Emergency department.