all patients referred to pulmonary rehabilitation receive effective and efficient individualised...

All patients referred to Pulmonary Rehabilitation

receive effective and efficient individualised delivery of the

programme Alison Maddigan & Chris Royle

Therapy Services

1

Project Registration No: 427

Project aim

• To ensure patients referred to the Pulmonary Rehabilitation programme in Peterborough run by PSHFT receive an effective, efficient and individualised programme that meets national standards

2

Project Objectives

• Impact on:– Staff – to determine whether current programme

meets national guidelines– Patients – to ensure the programme is available to

all those who meet the criteria and meets their needs as an individual in order to improve their quality of life

– Resources – to ensure limited resources in the local health economy are being utilised to full effect

3

Audit standard/s

4

Criterion

Target (%)

Exceptio

ns

Title or Reference of the above guidance/standard

(Evidence Base)Please insert NICE CG reference

1 Every patient referred to the Peterborough Pulmonary Rehabilitation service that is suitable for the programme is offered a place on the programme

100% IMPRESS Guidelines

2 Every patient offered an appointment for Pulmonary Rehabilitation attends their first appointment


3 Every patient deemed suitable for Pulmonary Rehabilitation completes Outcome Measures prior to commencing the programme


4 Every patient deemed suitable for pulmonary Rehabilitation completes outcome measures on completing the programme


5 Every patient deemed suitable for Pulmonary Rehabilitation is given the opportunity to complete a patient satisfaction questionnaire on completing the programme regarding their experience of rehabilitation

100%

Project Outline

• Prospective sample taken over 4 month period from Feb-May 2015

• Sample included every patient listed to attend Pulmonary Rehabilitation during the sample period with no exclusions

GS-2013 5

Data collection • The project was run through the only health –led

Peterborough based Pulmonary Rehabilitation with multiple operators of the various parts of the audit

• Prospective audit Feb-May 2015 (4 months)

• Information was collected from 2 databases, Scanman and a locally managed outcome measure database and anonymous patient questionnaires regarding the service they received

• Outcome measures used within service 6 minute walk test, COPD Assessment Test (Standardised across the Eastern Region) and Short version Breathing Problems Questionnaire

GS-2013 6

ResultsPatient Satisfaction Questionnaire demographics

GS-2010 7

Discussion regarding demographics of attendees of Pulmonary Rehab

• This outcome reflects the perceptions of those running the Pulmonary Rehab group both in age and nationality but not a true representation of those patients treated for conditions appropriate for Pulmonary Rehab treated on Ward B12 (Medical Respiratory)

• This lack of proportional representation of non ‘white British/English/Scottish’ in the sample taken may relate to language difficulties as they are currently the older generation many of whom do not speak English as a first language or cultural perceptions of disease management

GS-2010 8

Results for Standard 1 – every patient deemed suitable for pulmonary rehabilitation is offered an

appointment- 100%

• All referrals are triaged on the electronic referral review system Scanman. Inappropriate referrals are either rejected or where possible the referrer signposted to an alternative service

• Appropriate referrals are offered an appointment however during this time period this has been between 10 and 17 weeks from receipt of referral

GS-2010 9

Results for Standard 2 – every patient offered an appointment attends their first session

• Information taken from the Pulmonary Rehab attendance book

• During time period 72 patients were offered appointments and of these 49 attended their first appointment = 68%

• This could be due to– the patient group as they are not usually keen to exercise due to their

breathlessness, – a poor explanation of the course they are being referred to and the

rationale given at time of referral– the long time frame between referral and actual appointment due to

the waiting list

GS-2010 10

Results for Standard 3 – every patient deemed suitable for pulmonary rehab will complete a set of

outcome measures before commencing the programme• Every patient completes a 6 minute walk test at the venue

prior to commencing the programme to determine whether or not they require ambulatory oxygen in which to exercise and the level of the programme on which they start = 100%

• Number of patients submitting paper-based outcome measures after initial assessment = 33/49 patients who attended their first session =67%

• Every patient attending their first session is given paper-based outcome measures to complete in their own time however as their next session is often busy sometimes the patient forget to give these back or the staff forget to collect them from the patient

GS-2010 11

Results for Standard 4 – every patient deemed suitable for pulmonary rehab will complete a set of

outcome measures on completing the programme

• Every patient will be offered the opportunity to complete a final 6 minute walk test at the last of their 12 sessions unless they feel they cannot attend their last session due to another appointment in which case it will be offered at their last session.

• Of the 72 patients offered appointments during the audit period only 30 completed the course = 41%

• Of those patients who attended their first pulmonary rehab session 30/49 undertook a final 6 minute walk test =61%

GS-2010 12

Results for Standard 4 continued..

• Where possible patients due to complete their pulmonary rehab course are given their paper-based outcome measures at their penultimate session to complete during the days preceding their final session ready for handing to the staff

• Due to the large numbers of patients and how busy the sessions are this system is not always robust and often the patients forget to hand in the paper-based outcome measures/staff forget to obtain them from the patient

• Of the 49 patients who attended their first session 26 submitted paper-based outcome measure sheets = 53% (26/30 = 86% of those people completing rehab)

GS-2010 13

Results for Standard 5 – every patient completing pulmonary rehab will be given the opportunity to

complete an anonymous questionnaire regarding their experience

• 100% of patients completing the pulmonary rehab programme were given the opportunity to complete a questionnaire, 73% chose to complete a questionnaire and submit it

• This yielded 22 completed questionnaires

GS-2010 14

Average responses to Patient Satisfaction Questionnaire questions

GS-2010 15

Discussion regarding Patient Satisfaction Questionnaire results

• Most significant dissatisfactions were Q6 and Q7 which revolved around opportunities to join organised exercise programmes after finishing the free pulmonary rehab programme.

• Whilst this is covered in one of the education sessions this may be better covered in a face to face final summing up session to stress the importance of continuing to exercise, the benefits of group participation and reassuring the patients that it will be just like rehab but in a different place because we have worked with local providers to design the sessions as the majority of responses indicated they had really enjoyed the health based sessions

• Q10a-k referred to the education sessions delivered after the exercise session on a range of topics with a variety of internal and external speakers.

GS-2010 16

Results - Ideas for improvement to the programme

1. ‘Too popular leading to overcrowding hence need more staff’

2. ‘Breathing information session delivered at the start of the course’

3. ‘Option to attend evening sessions as working full time and managing children at school’

4. ‘3 times a week please’5. ‘Exercise classes free and on-going for the sick’

GS-2010 17

Discussion points regarding programme improvement ideas

1. The programme is not consistently full and suffers severe peaks and troughs based upon the ability to book patients in at short notice being limited and the time of the year

2. With a different design of class ‘breathing information session’ could be delivered at assessment/pre-course

3. Alternative session times were only requested by 1 respondent due to other commitments however it may be an area to look at as this could potentially be a valid reason for non-attendance at the initial session, especially as people are needing to work into later life and often take up some of the burden of childcare for working parents in their family

4. Number of sessions per week – this course is designed as a springboard to help patients to embrace exercise as part of their regular lifestyle. Potentially more work could be put into both ‘weaning’ the patients from pulmonary rehab and encouraging the completion of exercise diaries however these would need to be seen as valuable by both the staff running the programme so they are reviewed and the patients completing them

5. This is an interesting perception regarding being sick vs having a long term condition and self management strategies

GS-2010 18

Results - Elements most enjoyed from the programme

• Friendly atmosphere• Helpful staff• Encouragement to do well but with no pressure• Socialising with others with the same problems and

comparing notes/ideas• Cup of tea after exercise to get breath back• Good source of information• Useful both mentally and physically

GS-2010 19

Audit outcomes

GS-2013 20

Criterion

Target (%)

Achieved

(%)Compliant/Partially compliant/Non

compliant

1Every patient referred to the Peterborough Pulmonary Rehabilitation service that is suitable for the programme is offered a place on the programme

100% 100% Compliant

2 Every patient offered an appointment for Pulmonary Rehabilitation attends their first appointment 100% 68% Non-compliant

3 Every patient deemed suitable for Pulmonary Rehabilitation completes Outcome Measures prior to commencing the programme 100% 67% - 100% Partially compliant

4 Every patient deemed suitable for pulmonary Rehabilitation completes outcome measures on completing the programme 100% 53% - 61% Non-compliant

5 Every patient deemed suitable for Pulmonary Rehabilitation is given the opportunity to complete a patient satisfaction questionnaire on completing the programme regarding their experience of rehabilitation 100% 100% Compliant

Actions to be taken

GS-2013 21

Recommendation Action Required Lead Name

Progress review comments

Completion/Review Date

Progress Status

1

Review information available for referrers to both describe and inform patients regarding the service they are being referred to

Review of any available literature regarding the benefits of Pulmonary Rehab and the requirements of the local course and re-design as required A.Maddigan

AMBER – Basic pt information designed, needs to be translated into electronic format September 2015 A

2

Consider how patients can be assessed for the programme within a short time of being referred

Discussion with all parties involved in delivering the programme to develop new ways of working A.Maddigan

AMBER – System of alternative ways to assess patients for suitability underway

April 2016 A

3

Consider how the initial assessments can be conducted to improve the collection of paper-based outcome measure data

Discussion with all parties involved in delivering the programme to develop new ways of working A.Maddigan AMBER – as

above April 2016

A

Project Title Effective, Efficient and Individualised delivery of the Pulmonary Rehabilitation programme for patients referred to the programme

Project ID 427Project Completed By A.Maddigan & C.RoyleCompletion Date 30.06.15Re-audit Required Commence June 2016Directorate Clinical ServicesSpecialty Therapy Services

Progress Status Key: R for Red- No progress on the review date - A for Amber- Progress on schedule but not completed - G for Green- Completed on date

Actions to be taken

GS-2013 22

Recommendation Action Required Lead Name

Progress review comments

Completion/Review Date

Progress Status

4

Consider how final assessments are conducted to improve collection of outcome measure data at the end of the programme


RED - Meeting with all parties to be set up to consider options February 2016

R

5

Consider opportunities to ensure patients are as fully engaged as they can be to continue to exercise to maintain their improvement


RED - Meeting with all parties to be set up to consider options

February 2016 R

6

Consider how to stabilise class numbers to maintain effective yet efficient staff to patient ratios



February 2016 R

7Consider the timings of the class and the options available for people who work



February 2016 R

Progress Status Key: R for Red- No progress on the review date - A for Amber- Progress on schedule but not completed - G for Green- Completed on date

References

• IMPRESS Guidelines for Pulmonary Rehabilitation 2011

GS-2010 23

all patients referred to pulmonary rehabilitation receive effective and efficient individualised...

Documents