Trainee Advanced Nurse Practitioner
Place of work
Intensive Home Support Service (IHSS), East Lancashire Hospitals NHS Trust
The National Institute for Clinical Excellence (NICE) (2010) suggest that all patients who have COPD should be given symptom recognition advice, self-management strategies and contact numbers for appropriate health care services. Audit highlights that on discharge from the IHSS no patients received a self-management plan.
Compared to the rest of England, the North West has the highest numbers of patients with zero days’ length hospital stay (AQuA Analytics, 2014). As these patients who attended ED were deemed medically stable and well enough to be discharged, the author suggests that management at home with the IHSS as their first contact would have been more appropriate and cost effective.
To develop and initiate a personalised COPD ‘Flare up’ Action Plan (AP) to be left with patients on discharge from the IHSS. To encourage patient self-management of COPD and help seeking behaviour at the right time from the right health care service, consequently preventing unnecessary admission to hospital and General Practitioner (GP) consultations.
Kotters’ theory of change (1996) has been central to implementing the change in practice whereby an AP is initiated when discharging patients from the IHSS. Key stakeholders where identified to support and drive this project forwards. The plan was introduced to staff and promoted at via regular team meetings.
Donebedian’s framework (1966) was used to review the structure, processes and outcomes gained via further audit post project implementation. Monthly patient and staff satisfaction questionnaires informed the Plan, Do, Study, Act cycles (Langley, Nolan Norman, & Provost (2009) to develop the changes and improvements to the AP.
On discharge AECOPD patients receive an individualised Flare Up AP that will guide and promote symptom recognition skills and help seeking behaviour. Prompting them to ACT (Appropriate Care Timely) by requesting early IHSS intervention prevents inappropriate hospital admission/ED attendance.
Three key learning points
1. Good on-going communication is vital to promote and embed projects into everyday practice.
2. Be prepared to listen to others and adapt processes following feedback.
3. Development of simple ideas has the potential to change practice and improve patient care.