Improving quality in ward-based advanced respiratory support
by Dr Charlie Sharp
Quality Improvement Poster Download
Background & Problems
After the publication of the NCEPOD report, “Inspiring Change”, and national quality standards for non-invasive ventilation (NIV), it was clear that patients requiring ward-based support for respiratory failure were not receiving care meeting national quality standards. This was due to a variety of factors. This resulted in challenging working conditions and compromised quality of patient care, with a risk of increased inpatient length of stay and potentially higher inpatient mortality.
Aim
- To improve compliance with specific quality measures for delivery of advanced respiratory support to >70% before the end of November 2019.
- To reduce average length of stay for those receiving ward-based NIV and nasal high flow oxygen (HFNO) by 2 days by March 2019.
- To reduce inpatient mortality with acute NIV to <20% by December 2019.
Method
A project of work was started to address these concerns and has included several PDSA cycles, along with stakeholder engagement of Respiratory ward nurses, Acute Care nurses and the Respiratory medical teams. This project is in progress.
Introduced:
- Prescriptions and checklists for ward-based NIV and HFNO
- Dedicated Respiratory High-Acuity Bay on ward 8B with consultant-controlled admission
- Education programme for doctors-in-training
- Regional QI collaborative (Bristol/Bath/Gloucestershire/Swindon) for sharing of experience and peer benchmarking
In planning:
- Patient and carer information leaflet
- Patient experience survey
- Real time data and outcome monitoring and publicity to raise awareness within the trust.
Results
This is an ongoing project, however some early results have been seen:
- Improved UP form completion
- Introduction of dedicated High Acuity Bay has led to a more controlled nursing environment.
There are many ongoing challenges, including prescription completion and the need to confirm improved working environment.
Implications
- Reductions in length of stay may be possible
- Supported decision making has led to improved senior clinician involvement
- The causes of low prescription completion rates remain unclear.
| Quality Improvement Presenter(s) |
|---|
| Dr Charlie Sharp, Respiratory Consultant |
| Quality Improvement Team |
|---|
| Catherine Matthews, 8B Ward Manager |
| Sue Macklin, Avening Ward Manager |
| Eve Olivant, Respiratory Matron and Specialty Director |
| Alli Patchett, ACRT Nurse |
| Avening and 8B ward nurses |
| Respiratory Medical Teams |