Kimberley Wood

​Name
Carolyn Sweetland 

Role
Trainee Advanced Nurse Practitioner 

Place of work
Intensive Home Support Services, Primary Care, East Lancashire Hospitals NHS Trust 

Background 
Inhaled medication remains the preferred route of administration for the treatment of COPD and Asthma (Barnett 2012). The aims of inhaled therapy are to achieve optimal disease control by limiting exacerbations and symptoms, improving lung function and quality of life.
 
Currently there is a lack of formal training delivered to healthcare professionals on the correct use of inhaled medications (Bades, 2012), despite worldwide recommendations made by NICE (2011) and GOLD (2011). The evidence suggests that many nurses are not experienced at assessing or teaching inhaler technique to their patients (Self et al. 2007) with 94% of previously educated patients continuing to practice an incorrect technique (Souza et al. 2009).
 
Internal audit results using nursing volunteers demonstrated that the required steps for effective inhalation were performed inadequately by 19 out of the 20 participants, further highlighting the necessity for increased education in this area of practice.
 
Aim

• To increase staff knowledge, competence and confidence with inhaler devices.
• To standardise the quality of training given to healthcare professionals on inhaled therapies.

 
Method 
An eight stage change model devised by Kotter (1996), with expertly driven training delivered by Respiratory Specialists, demonstrated exact teaching methods using placebo devices, in conjunction with video and PowerPoint presentations. Written literature, diagrammatic references and placebo inhalers issued to staff reinforced their learning and provided a further resource to be used in patient education.
 
Evaluation 
The Project’s efficacy was evaluated using concepts influenced by Donabedian’s (1966) and Kirkpatrick’s (1994) evaluation models. A pre and post education survey identified staff knowledge of inhaler therapies both pre and post education delivery, thus indicating that the multi-faceted training program has proved successful. Finally, staff and patient satisfaction surveys identified any deficiencies in the proposed regime and indicated where further training is required.
 
Conclusion  
The implementation of a multi-faceted teaching strategy to improve inhaled therapy education amongst nursing staff enhanced patient care.
 
Three key learning points  
1. Lack of formal inhaler training leads to inconsistencies with delivery of patient education.
2. NICE Guidelines (2011) recommend that all healthcare professionals involved in the education of patients regarding inhaler use are up to date with current knowledge and have undergone adequate training.
3. A multi-faceted staff teaching strategy could be used to assist with optimal disease control, limit exacerbations and improve patients’ quality of life.

​Name
Olga Byrne

Role
Trainee Advanced Nurse Practitioner

Place of work
Intensive Home Support Service (IHSS), East Lancashire Hospitals NHS Trust

Background
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.  

Aim
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.

Methods
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.  

Evaluation
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. 

Conclusion
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.