Primary Care Bundle How many people can you help to stop smoking today and encourage to set a quit date in the next two weeks? How can you improve someone s quality of life today, reduce their risk of exacerbations and their symptoms? How do you know your patient is on the right medicines? What can your practice team do? How well do they do it? How often do you discuss what is needed to improve? How can you create discretionary effort?
Primary Care Bundle ENGAGE 5 R s for motivating patients to quit smoking: Relevant; Risks, Rewards, Roadblocks, Repetition EMPOWER Self-Mx knowledge & skills; Puffers & spacers; what do I need to do & why? ENABLE Spirometry risk assessment; guiding Mx & reducing Sx & exacerbation risk ENABLE High performing teams: 5 P s: Purpose, People, Professionals, Process, Patterns; Change Mx: 7 S s: Hard (3): Strategy, Structure, Systems; Soft (4): Style, Shared Values, Staff, Skills; regular feedback, coaching, collaborative approach to problem solving
Primary Care Bundle To identify those pts 40y+ with suboptimal control of their asthma &/or COPD To improve the selfmanagement knowledge & skills of those with suboptimal control To increase the no. of treated smokers who have successfully quit after 4wks, 6mths & 1year To increase the no. of referrals for spirometry and Pulmonary Rehab
Smoker or Ex-smoker 40y+ Smoker wants to quit? Ask again at next visit Set Quit Date Completes ACT Known asthma? Completes CAT Smoking cessation EBI Annual influenza vaccine if known COPD ACT <20? CAT 10+? Eligible for Champix? See GP Check PEFR Eligible for Rx only Spirometry if none in last 12mths COPDX (BBC Care Bundle) Refer for PR if appropriate SA for Champix Review at 4wks Try NRT patches & gum
Pt 40y+ Do not enrol Go to SCREENING in Patient Manager; filter SKE terms only Smoker or ex-smoker? Do not enrol KA alert code present? Give CAT survey to pt Give ACT survey to pt Enter CAT in note column of pt queue next to pt name Enter ACT in note column of pt queue next to pt name
Patient completes ACT or CAT survey; nurse enters result in ACT or CAT screening template Check inhaler & spacer technique & crisis plan; print all three patient education documents from the ACT or CAT screening template ACT score <20 or CAT score 10+? If patient smoker, print smoking cessation document from the SKE template & perform smoking cessation EBI
Nurse enters CAT score into CAT screening template Known COPD? Doctor checks CAT screening template; CAT 10+? If smoker, use SKE screening template to assess dependency, EBI for smoking cessation, discuss strategies for trying to quit & try to set quit date, offer NRT+/-Champix & smoking cessation support Spirometry in last 12mths? Refer for spirometry; note MRC Dyspnoea Score; assess sleep duration & when first wakes; perform respiratory exam Follow COPDX Guidelines (BBC Primary Care Bundle); use YOC screening template
Ms F.V. 53y, Niuean Ex-smoker Asthma ACT score 12; PEFR 110 L/min CAT score 11 (wet & wheezy) O2 sats 93% OA mmrcds 1 >2 exacerbations/yr 0 hosp adm last yr BMI 31.8 Pneumovax Dec 2011 Fluvax May 2012 Ventolin & Seretide Declined PR; Educ given Duolin qid & prn FEV1.0% Pred 44% PEFR 220
Take Home Messages COACHING Having systems and processes wasn t enough; role play it helps to identify strengths & weaknesses; 360 deg checklists everyone learns together COMMUNICATION Find some small wins to celebrate each week; they can have BIG pay-offs! (increased discretionary effort). Regularly acknowledge everyone s efforts & the areas for improvement COMPETITION Find ways to have fun at work! (BIG payoff - increased discretionary effort)