NHS TAYSID RSPIRATORY MANAGD CLINICAL NTWORK BOARD TAYSID RSPIRATORY MANAGD CLINICAL NTWORK: 2013-14 ANNUAL RPORT The Respiratory MCN Work plan for 2013-14 was agreed by the Respiratory MCN xecutive Board in May 2013 and supported by the Joint Clinical Governance Board June 2013. Attached is an end year report setting out the progress on each of the actions to May. The actions incorporate priorities from the Chronic Obstructive Pulmonary Disease Services (), Asthma Services for Children and Young People () and SIGN 101 British Guideline on the management of Asthma (101). The Group is asked to note the report and provide any comments on progress and/or outstanding actions. Respiratory Managed Clinical May Achieved In progress within timescale some delay to timescales/progress No progress 1
RSPIRATORY MCN ANNUAL RPORT 2013-14 Healthcare Improvement Scotland Clinical Standards Healthcare Quality Strategy Chronic Obstructive Pulmonary Disease Services () Person Centered () Asthma Services for Children and Young People () Safe (S) ffective () SIGN 101 British Guideline on the management of Asthma Timely (T) PRSON CNTRD CAR 1 Outcome: Increase Individual Healthcare Plans in Schools 1.1 A reporting template has been adopted by each CHP to inform the effect of the agreed guideline and their implementation. March Angus Dundee Perth CHP s & Paediatric Asthma The 3 local CHP s have an agreed guideline/protocol in place. This is now implemented in each CHP. A standard reporting template has been adopted by each CHP to inform the effect of the guidelines and their implementation. CHPs are responding to this template and working with education departments to facilitate reporting arrangements. CHPs report varying levels of engagement from schools across Tayside. 1.2 All children and young people in school have an individual healthcare plan relevant to their needs Increase number of children recorded on school asthma register. March Angus Dundee Perth CHP s & Paediatric Asthma See local register - appendix Achieved In progress within timescale some delay to timescales/progress No progress 2
PRSON CNTRD CAR 2 Outcome: Smooth transition of asthma care from children s service to adult care 2.1 Individually planned transitional programme of care for children 14-16 years old with asthma. Number of young adults assessed in transition clinics - Dundee February T Paediatric Asthma Group/Mary Malone NHS Tayside Respiratory Transition Service March 2013-Feb Since September 2013 the clinics are now every 2 months. 7 new referrals - 4 from paediatrics, 2 from Primary care, 1 from ward 3 9 attended 3 DNA 5 discharged to Primary Care 1 into adult services 3 still attending transition Clinic attendance 1-6 occasions, longest attended for 2 years March Update 2 monthly clinics 3 regular attendees with 2 new referrals at each clinic Referrals from paediatrics, Primary Care, acute admissions to adult wards. Next clinic March with 5 patients 3 new referrals Number of young adults assessed in transition clinics Perth Paediatric Asthma Group/Helen Donald Total 17 patients at transition clinic 2 patients failed to attend any further appointments after initial transition 4 patients discharged back to GP 9 patients have appointments coming up in 12 occasions where patients failed to Achieved In progress within timescale some delay to timescales/progress No progress 3
attend appointment PRSON CNTRD CAR 3 Outcome: Reduction of emergency admissions to ITU and Length of Stay 3.1 Actively promote the uptake of pneumococcal and flu vaccine across Tayside. Promote increase in the uptake of flu and pneumococcal vaccine from people with respiratory disease. Actively promote the benefits of the pneumococcal and flu vaccine across Tayside for Respiratory patients. Twice a year Managed Clinical MCN Patient/Staff Newsletters promote uptake/delivery. Information sent to GP/Practice Managers/Primary & Secondary Care. Reminder at annual education events. Graph below- from QOF audits No data available against Asthma and influenza vaccine. Achieved In progress within timescale some delay to timescales/progress No progress 4
QOF Database 2013 Data for Scotland : Patients who have influenza vaccine 3 Outcome: Reduction of emergency admissions, admissions to ITU and Length of Stay (continued) 3.2 Pulmonary Rehabilitation is April Group ach CHP offers local solutions available, and offered to people with an MRC 3 and hospital Dundee/Angus/ Dundee admission with an exacerbation. P&K CHPs No of people referred to Pulmonary Rehabilitation No of people attending Pulmonary Rehabilitation No of people who had completed Pulmonary Rehabilitation (as a percentage) No of people on waiting list for Pulmonary Rehabilitation % population referred to Pulmonary Rehabilitation Pulmonary Rehabilitation Team Referral to assessment generally within about 3 weeks, most patients start classes within 6 weeks and all patients consistently seen in less than 12 weeks. Fast track into programmes for patients post hospital admission for exacerbation or as needed if deterioration. Perth and Kinross Referral to treatment at PRI within a range of 8-12 weeks. However over the winter period this has increased slightly with a small amount of patients waiting about 14 weeks. Post inpatient exacerbation within about 2 4 weeks. Although this may be longer if patient requests to be seen at a specific venue. Achieved In progress within timescale some delay to timescales/progress No progress 5 Angus Referral to assessment will be within 6 weeks and referral to treatment within 12 weeks. Angus offer a postexacerbation service on discharge from hospital and patients are fast-tracked into Pulmonary Rehabilitation within 4 weeks of discharge, if fit to attend
3 Outcome: Reduction of emergency admissions, admissions to ITU and Length of Stay (continued) 3.3 Ongoing review of oxygen therapy Patients prescribed home oxygen April Managed services to provide appropriate therapy, are reviewed within four Clinical levels of support across Tayside weeks of commencement. for patients that receive oxygen at home. Work with the respiratory team and primary care teams within Tayside to improve the pathways & education for patients receiving new oxygen therapy. T All patients receiving home oxygen have an agreed date for review by an identified clinician or clinical team. Respiratory Liaison Service Sub Group ducation for patients receiving new oxygen therapy should be provided. Pathway reviewed and published Oxygen is not solely provided for patients with, but at present NHS Tayside has 479 patients registered receiving oxygen therapy of which approximately 236 are or have a component. 90% reviewed within 4 weeks. The 10 % that do not meet the criteria are either reviewed at clinic of the patient themselves have chose not to be reviewed. 100 % of patients prescribed home oxygen therapy are reviewed annually within Tayside. 100 % of patients who receive new oxygen therapy receive the appropriate education Recent update to scenarios for oxygen provision for travel/holidays. 3.4 Through the use of good practices, education events, guidelines, improvement bundles reduce hospital admissions due to acute asthma Reduce number of children admitted to hospital due to acute asthma with multiple admissions Reduce number of adults admitted to hospital due to acute asthma with multiple admissions Reduce number of children and adult admitted to hospital by completing an audit of asthma care bundle being used to provide advice and support for self management May Managed Clinical Paediatric Asthma Group Adult Asthma Group As part of the ongoing audit and evidence of best practice care for all patients, children and adult with asthma. A records audit of five patients with multiple admissions due to exacerbation of asthma is carried out by the MCN team annually. (postponed due to staff illness) The charts on the following page detail admissions excluding transfers for the treatment of asthma for Angus/Dundee & P&K by age. Achieved In progress within timescale some delay to timescales/progress No progress 6
Figure 2.1 Tayside HB GP Practice Population - Rate (per 100,000 GP population) of mergency Admissions (Only) for the Treatment of Asthma within NHS Tayside for those Aged Under 15 years Figure 2.1 Tayside HB GP Practice Tayside HB Practice Rate: Asthma mergency Admissions for those Aged Under 15 years Figure 2.2 Tayside HB GP Practice Population - Rate (per 100,000 GP population) of mergency Admissions (Only) for the Treatment of Asthma within NHS Tayside for those Aged 15 years and Over Tayside HB Practice Rate: Asthma mergency Admissions for those Aged 15 & Over Rate per 100,000 (GP Pract.) Population 90 80 70 60 50 40 30 20 10 00-04 yrs4 05-14 yrs Rate per 100,000 (GP Pract.) Population 10 9 8 7 6 5 4 3 2 1 15-64 yrs 65+ yrs Figure 3.1 Tayside HB GP Practice Population - Rate (per 100,000 GP population) for the "Total Length of Stay" (Days per Year) for the Treatment of Asthma within NHS Tayside for those Aged Under 15 years Figure 3.2 Tayside HB GP Practice Population - Rate (per 100,000 GP population) for the "Total Length of Stay" (Days per Year) for the Treatment of Asthma within NHS Tayside for those Aged 15 years and Over Rate per 100,000 (GP Pract.) Population 40 35 30 25 20 15 10 5 Tayside HB GP Practice Rate: Asthma Total Length of Stay (Days) for those Aged 15 & Over 15-64 yrs 65+ yrs Rate per 100,000 (GP Pract.) Population 120 100 80 60 40 20 Tayside HB GP Practice Rate: Asthma Total Length of Stay (Days) for those Aged Under 15 years 00-04 yrs4 05-14 yrs Figure 4. Tayside HB GP Practice Population - Rate (per 100,000 GP population) of Persons with "2+" mergency Admissions for the Treatment of Asthma within NHS Tayside by Age Band 2+ mergency Admissions for the Tayside HB / GP Population Treated for Asthma Rate per 100,000 (GP Pract.) Population 9 8 7 6 5 4 3 2 1 2+ merg. Admissions (00-14yrs) 2+ merg. Admissions (15+yrs) Achieved In progress within timescale some delay to timescales/progress No progress 7
3 Outcome: Reduction of emergency admissions, admissions to ITU and Length of Stay (continued) 3.5 Through the use of good Measure of compliance with May Managed practices, education events, care bundle. Clinical guidelines, improvement bundles reduce hospital admissions due to Tayside wide agreement of referral PR referral criteria now standardised.. criteria for Pulmonary Rehabilitation. Group Measure capacity and demand for pulmonary rehabilitation following exacerbation of. R ate per 1 00,000 (G P P ract.) P opu latio n 40 35 30 25 20 15 10 5 Tayside HB GP Practice Rate: Total Length of Stay (Days) for those Aged Under 65 years R at e p e r 1 0 0,0 00 (G P Pract.) Population 800 600 400 200 Tayside HB GP Practice Rate: Total Length of Stay (Days) for those Aged 65 & Over 2+ mergency Admissions for the Tayside HB / GP Population Treated for 20 Rate per 100,000 (GP Pract.) Population 15 10 5 2+ merg. Admissions (00-64yrs) 2+ merg. Admissions (65+yrs) Achieved In progress within timescale some delay to timescales/progress No progress 8
SUPPORT SLF MANAGMNT 4 Outcome: Provide effective self management information to support people with respiratory disease 4.1 Patient information packs will increase patient knowledge of which will include self management/exacerbation guidance Leaflets reviewed and updated No of packs distributed, by practice Patients experience Sept 13 Sept 14 Group MCN has developed a patient information pack which includes self management/exacerbation guidance. MCN also developed a Respiratory Medication Rescue Pack to be distributed to patients as required. 1045 Patient information packs & 594 medication rescue packs distributed to 38 practices. vidence based care pathway for vidence based care pathway for acute Adult Asthma It is proposed to evaluate the effectiveness of the new pack in the next 12 months. A evaluation form has been developed and distributed. Patient experience 4.2 MCN continues to encourage the use of Asthma Self Management Plans particularly following asthma exacerbation. VIDNC BAS AND CLINICAL XCLLNC 5 Outcome: Respiratory Care Delivery is based on recognised evidence based practice 5.1 Review of pathways Pathways reviewed and published MCN ongoing changes will be made throughout this period, if required 30/04/14 Group In progress 31/07/15 Adult Asthma Group vidence based care pathway for Paediatric Asthma 31/08/15 Paediatric Asthma Group Achieved In progress within timescale some delay to timescales/progress No progress 9
5.2 Tayside Area Formulary provides prescribing advice for all respiratory conditions, relating to best practice evidence based care S//T Formulary Group will consider new medications for inclusion on Tayside Area Formulary/Asthma/ Guideline following approval by Scottish Medicines Consortium. 30/04/14 Formulary Group Formulary group has met on a regular basis to review new medicines and has updated and Asthma guidance in Tayside Area Formulary. Adult Asthma Inhaled Medicine Chart developed and distributed. Adult Inhaled Medicine Chart updated Formulary choices reviewed and updated Tayside Prescriber 131 Tayside Prescriber 132 VIDNC BAS AND CLINICAL XCLLNC 5 Outcome: Respiratory Care Delivery is based on recognised evidence based practice 5.3 As part of the ongoing audit and evidence of best practice care for children & adults. An audit to be carried out of patients who have multiple admissions due to exacerbation of asthma is carried out by the respiratory MCN annually Reduce number of children admitted to hospital due to acute asthma with multiple admissions Reduce number of adults admitted to hospital due to acute asthma with multiple admissions 30/04/14 MCN Team Adult Asthma Paediatric Asthma Audit postponed to staff absence. Reduce number of children and adult admitted to hospital by completing an audit of asthma care bundle being used to provide advice and support for self management. Achieved In progress within timescale some delay to timescales/progress No progress 10
5.4 Respiratory MCN Spirometry Training and Accreditation. The MCN will develop performance criteria for health professionals using the equipment and devices to monitor or measure an individual s physiological lung condition in a health care setting. It covers the equipment used, calibration/verification infection control, the technical requirements and the interpretation of common spirometry patterns, and when to refer for further and more complex testing. This will include a schedule for re-accreditation of health professionals to ensure competence maintained. A needs assessment has been sent out to all practices requesting an update on spirometry testing, qualifications and last update. April MCN Team Needs Assessment completed. Summary attached, CHP details will be sent to CHP managers/clinical leads. MCN xecutive to review. has continued to explore opportunities for Spirometry reaccreditation. Current proposal is to use Learn Pro Spirometry Module (in development) and combine this with review of patient spirometry results and interpretation by Respiratory Specialists. Proposed that all staff update spirometry practice every 3 years VIDNC BAS AND CLINICAL XCLLNC 6 Outcome: ducational opportunities are available for private and public sector workers supporting people with respiratory disease 6.1 NHS Tayside Respiratory resources are utilised to support respiratory care effectively. S 30/04/14 CHPs MCN Team Respiratory ducation Needs Assessment sent out to all Practices within Tayside to identify educational organisational requirements. Needs Assessment completed. MCN xecutive to review. Achieved In progress within timescale some delay to timescales/progress No progress 11
6.2 Respiratory MCN Team conducts an evaluation for the education events and provides a section to all staff of all disciplines to raise training needs. valuation of education events and review of feedback The education events, 2013/14 were well attended with increasing numbers and positive feedback which informs future content. 6.3 NHS Tayside Respiratory MCN provides a rolling programme of education to meet the needs of clinical staff. S Multi disciplinary spread of attendees valuation of education events Varied professionals attended both the & Asthma ducation vents over the year. Including care home staff, paramedics and pharmacy colleagues. valuations of the events are available on the MCN Website. These are used to inform future programme content and delivery. VIDNC BAS AND CLINICAL XCLLNC 5 Outcome: Clinical Services are evidence-based and acknowledge the importance of peoples experiences as a measure of quality 7.1 Patient experiences of asthma care pathways are evaluated. March Adult/Paediatric Asthma Group Not repeated in 2013-14 Hospital admission due to acute asthma questionnaire devised and to be tested at follow up clinic Managed Clinical Achieved In progress within timescale some delay to timescales/progress No progress 12
7.2 Patients experiences of proposed patient information packs are evaluated. March Managed Clinical A evaluation form has been developed and distributed in 50 packs. Safe, effective, timely care 8 Outcome: Development of IT system to support clinical care and service improvement 8.1 Continue to develop an IT system March Managed to support clinical care and Clinical service improvement. S Community Nursing NHST IT department have developed a clinical system-based on MIDIS. This is being used by Dundee and Angus CHP nurses, the Tayside Respiratory Liaison Service and Dundee CHP Pulmonary Rehabilitation Service. The information on this system can be read by practice staff via MIDIS. All community staff have been trained on the MIDIS System and the system went live August 2013. The future is to develop the system to allow transfer of information from MIDIS to the GP IT systems (Vision/MIS) and in time from GP systems to MIDIS Stewart Hunter Associate ehealth Director reports that MIDIS intergration with GP systems has been delayed but remains a priority for this financial year. Secondary Care staff can now apply for access to review CS/KIS records created by primary care via Clinical Portal. Achieved In progress within timescale some delay to timescales/progress No progress 13
srkine Practice and Family Medical Group are to pilot the use of i in summer. Reduce Health Inequalities and Promote Collaboration 9 Outcome: Increase public involvement and respiratory network 9.1 nsure that people living with a March Patient Group respiratory disease have the opportunity to engage in all MCN activities. Managed Clinical The MCN patients group has been active for 15 months. Members of the patient group also contribute to MCN subgroup work/meetings. Members of each patient group from across Tayside participate fully in recognised event days throughout the year. November 2013, Angus Patient Group met Catherine Stihler MP to discuss care. Catherine Stihler said: It was a privilege to come to Forfar and see the great work being carried out to support people with. The support and cooperation that exists between the peer support groups and NHS Tayside is a fantastic example for others in Scotland and the U to follow. The people of Angus who make up the local peer support groups do great work to help their fellow sufferers but want to see the same support across the Achieved In progress within timescale some delay to timescales/progress No progress 14
country for all who are diagnosed with. I will be speaking to colleagues to continue the fight for recognition of as a major disease and to push for co-ordinated strategies at local and U levels to tackle the disease. All NHS boards than received FOISA request for update re support for groups and availability of pulmonary rehabilitation in communities. See NHST report. 9.2 Respiratory MCN participates in public awareness events SIGN 101 March Patient Group Managed Clinical. World Day, World Asthma Day and Long Term Conditions Day (which incorporated both & Asthma) were attended by MCN Staff, patients carer, employees and family members. The patient newsletter is developed by the Patient Group and MCN staff. Four newsletters have been distributed since group formed. Jayne Roberts Dr Peter Slane MCN Co-ordinator MCN Lead Clinician Achieved In progress within timescale some delay to timescales/progress No progress 15