Implementing the Respiratory Health and Wellbeing Service

Framework Through the Development of

Nurses and Midwives

Angela Drury Angela Drury

Senior Professional Officer, NIPECSenior Professional Officer, NIPEC

What is a Service Framework?

Focus on Service Focus on Service Users and CarersUsers and Carers

Set Clear Evidence Set Clear Evidence Informed StandardsInformed Standards

Aim?Improve health and well-being

Reduce variation and inequalities in treatment and care

Link public health with safe and effective care

Patient/client Pathway Template

Prevention / PromotionProtection /Lifestyle

Treatment

Ongoing Care / Chronic DiseaseManagement

End of Life Care / Palliative Care

Assessment & Diagnosis

Overarching Standard 6.1.1All people suspected of having COPD should have accurate assessment, diagnosis and management in Primary Care.

RationaleCOPD should be prevented where possible, but, as a minimum, disease progression should be slowed down or avoided by early diagnosis and optimal management in keeping with the most up to date evidence based guidelines.Evidence National Institute for Clinical Excellence (2004) Management of chronic obstructive pulmonary disease in adults in primary and secondary care. National Institute of Clinical Excellence: Londonhttp://thorax.bmj.com/content/vol59/suppl_1/Strategic Framework for Respiratory Conditions (N. Ireland), 2006. http://www.dhsspsni.gov.uk/pcd_-_respiratory_framework.pdf

Responsibility for delivery / implementationHSC TrustsPrimary Care

Quality Dimension 1.All patients older than 35 years, with past/present smoking history, and presenting with exertional breathlessness, chronic cough, regular sputum production, frequent winter bronchitis or wheeze should have spirometry performed. 2.All patients with a diagnosis of COPD should have an assessment and review according to NICE guidelines 3.All patients suspected of or diagnosed with COPD should have their smoking history recorded and be given appropriate advice about smoking cessation and specialist smoking cessation services.

Performance Indicator Data Source Expected Performance Level

Date to be achieved by

Percentage of patients with COPD who smoke, who have had appropriate smoking advice

DES Data setAudit of GP records

60%80%90%

March 2010March 2011March 2012

Percentage of patients with COPD who are assessed, diagnosed and managed according to NICE Guidelines in primary care.

DES datasetRolling audit of GP records

60%80%90%

March 2010March 2011March 2012

Current Work

Cardiovascular DiseaseCardiovascular Disease

Respiratory WellbeingRespiratory Wellbeing

CancerCancer

Mental HealthMental Health

Learning DisabilityLearning Disability

Spring 2009Spring 2009

May/ JuneMay/ June20092009

Summer Summer 20092009

Project Aims – To Produce:

1. A strategy to support the learning and development of nurses (and midwives)

2. A framework to support competency development

…..in order to assist the implementation

of the Asthma and COPD RHWSF standards.

June 2007June 2007Asked by RHWSF

Steering Group to assist production of L&D Strategy

January 2008January 2008Steering GroupSteering Group

Appointment PMAppointment PM

Learning Needs

WorkshopFebruary 2008February 2008

Expert Working GroupMay 2008May 2008

May – June 2008May – June 2008Development of

Competency Framework/ Strategy

June 2008June 2008Consultation

Workshop

Publication of Publication of Strategy and R-CAT Strategy and R-CAT

November 2008November 2008

October 2007October 2007FundingFunding

CNOCNO

SGSG18/4/0818/4/08

SGSG21/7/0821/7/08

SGSG25/1/0825/1/08

http://www.nipec.n-i.nhs.uk/pub/RHWSF%20final%20report.pdfhttp://www.nipec.n-i.nhs.uk/pub/RHWSF%20final%20report.pdf

Need to Need to do better?do better?

COPDCOPD

Need to Need to do better?do better?

AsthmaAsthma

Not do Not do at all?at all?COPDCOPD

Not do Not do at all?at all?

AsthmaAsthma

Tier 1Tier 1

Tier 2Tier 2

Tier 3Tier 3

Core Learning And Core Learning And DevelopmentDevelopment

1. Holistic assessment and diagnosis

2. Management and monitoring of chronic relapsing respiratory disease (asthma and COPD)

3. Communication

4. Patient education and enhancing self-management

Assessment and Monitoring Assessment and Monitoring ActivitiesActivities1.1. Pulse oximetryPulse oximetry2.2. Arterial Blood GasesArterial Blood Gases3.3. Peak Expiratory Flow RatesPeak Expiratory Flow Rates4.4. Pulmonary Function TestingPulmonary Function Testing5.5. TelehealthTelehealth6.6. Allergy testingAllergy testing

Technological InterventionsTechnological Interventions1.1. Inhalers Inhalers 2.2. Nebulisers Nebulisers 3.3. Oxygen therapyOxygen therapy4.4. Non-Invasive VentilationNon-Invasive Ventilation

Health PromotionHealth Promotion1.1. Smoking Cessation/ preventionSmoking Cessation/ prevention2.2. Exercise and Pulmonary Exercise and Pulmonary rehabilitationrehabilitation

How can the R-CAT help nurses and midwives to implement the RHWSF

standards?

Through…..

Appraisal Appraisal

RevalidationRevalidation

Professional Professional SupervisionSupervision

New New ServiceService

DevelopmentDevelopment

Continual Continual ProfessionalProfessionalDevelopmentDevelopment

PDP PDP Production Production

Induction Induction Learning needs analysis Learning needs analysis

The building blocks of competence

and quality service provision

Appraisal Appraisal

RevalidationRevalidation

Professional Professional SupervisionSupervision

New New ServiceService

DevelopmentDevelopment

Continual Continual ProfessionalProfessionalDevelopmentDevelopment

PDP PDP Production Production

Induction Induction Learning Learning needs analysis needs analysis

Education Commissioning/ Curriculum PlanningEducation Commissioning/ Curriculum Planning

1. Select the appropriate Tier of Practice1. Select the appropriate Tier of Practice

2. Self-assess…..

1.Needs a lot of development2.Needs some development

3.Is well developed

√

√

√

Identify what it is you need to learn and develop

Draw up an action plan of how you will do this with a colleague or supervisor

Take small chunks of learning in 6-8 weekly cycles

Assessment and Monitoring Activities

(6)

Technological Interventions

(4)

Health Promotion(2)

Core Learning and Core Learning and DevelopmentDevelopment

(4)(4)

So then what?

3. Work through 4 core domains first- Small bites of learning

- Flexible learning activities

4. Choose from the supplementary domains

Link to …….

www.nipecdf.orgwww.nipecdf.org