heading towards a copd care pathway - scottish...

1

Mario Heirewegh

az Sint-Blasius Belgium

Heading Towards a COPD Care Pathway

June 20, 2013

Dr Luc Van Zandweghe Mario Heirewegh

Pulmonologist Head Nurse

AZ Sint-Blasius Dendermonde Belgium

2

Mario Heirewegh


AZ Sint-Blasius

Where We Are Located

Dendermonde Zele

AZ Sint-Blasius is a merger of five local hospitals established between

1976 and 1999 in East Flanders, Belgium, consisting of two campuses.

.

3

Mario Heirewegh


AZ Sint-Blasius

Basic Figures

Beds: 440

Staff: 1,268 (in 2012)

Turnover: 125,000,000 Euros in

2012

Hospitalization: 17,380 in 2012

Consultations: 18,096 in 2012

4

Mario Heirewegh


AZ Sint-Blasius

Organization M

atr

ix s

tructu

re

Care Units (eg. abdominal, thoracic,..)

Care Supporting Services (eg. labo, medical imaging,..)

Organisation Supporting Services (eg. HR, ICT,..)

Focus on process management (eg. clinical pathways, SLA’s)

5

Mario Heirewegh


Carepathways in AZ Sint-Blasius

History Since 2003 member of Belgian Dutch Clinical Pathway Network

Hospital wide implementation ( each ward >= 1 careplan)

2003-2009 : focus on development and implementation

2010-2012: focus on follow-up,analyzing,keeping alive….

Evolution from central ( staff member) to decentral

follow- up- evaluation

Participation Network workgroups ( COPD, PFF)

Evolution

6

Mario Heirewegh


Composition

Multidisciplinary Treatment Team COPD

3 pulmonologists

2 fysiotherapists

1 occupational therapist

1 psychologist/ tobaccologist

1 dietitian

1 social worker

headnurse and nursing staff

weekly multidisciplinary consultation on thursday

7

Mario Heirewegh


8

Mario Heirewegh


Thoracic Care Unit

hospitalization ward : 34 beds

16 FTE nurses, 3 nurses

specially trained in pulmonology;

main responsibles for patient

education

mostly lung patients

combination of both internal and

surgical pathology

21 rooms from which 4 negative

pressure isolation rooms

1,863 admissions in 2012

average LOS: 5 days

9

Mario Heirewegh


What ‘s in a word ?

Chronic

Obstructive

Pulmonary

Disease

© Global Initiative for Chronic Obstructive Lung Disease

10

Mario Heirewegh


What is COPD?

Risk Factors

Food Habits

Infections

Socio-Economical

Status

Aging

Global Initiative for Chronic Obstructive Lung Disease

11

Mario Heirewegh


What is COPD?

Epidemiology

COPD is considered one of the leading causes

of death world wide and in the coming years

will become increasingly more important.

The current anti-smoking campaigns will pass

within decades which governed.

In Belgium, the number of COPD patients is

estimated at 680,000. Less than half of those

have been diagnosed.

2009: 190 admissions in AZSB

2010: 141 admissions in AZSB

© Global Initiative for Chronic Obstructive Lung Disease

12

Mario Heirewegh


What is COPD?

Epidemiology

COPD is one of the

six leading causes of

death in the U.S.

with an increasing

trend since 1970!

Source: US Centers for Disease Control and Prevention, 2011

COPD

13

Mario Heirewegh


What ‘s the effect

of COPD?

14

Mario Heirewegh


What is COPD ?

Pathogenesis

INFLAMMATION

Small airway disease

Airwayinflammation

Airway-remodeling

Lung tissue damage

Loss of alveoli

Decreased elasticity

AIRWAY

LIMITATION

15

Mario Heirewegh


What is COPD?

Symptoms

cough

over production of mucus

dyspnea:

exercise-induced

exacerbation during surge

wheezing

typically, slowly progressive symptoms

16

Mario Heirewegh


What is COPD ?

Treatment Aimed At :

prevention of disease progression

relief of symptoms

improve exercise tolerance

improving the general health status

prevention and treatment of exacerbation

prevention and treatment of complications

prevention of mortality

17

Mario Heirewegh


Occupational therapy and COPD

COPD influence on daily life tasks and Q.o.L.

Occupational therapist part of the multidisciplinary team

Education (patient and family)

Identify the limitations in ADL tasks

(interview, home evaluation scale, AMPS,...)

Skills training

(attention for breath control and energy efficiency)

If needed the OT gives information to adapt the environment

or advises device assistance

to increase participation in everyday life

to increase performance of daily activities

•

18

Mario Heirewegh


Progress Of The Path:

May 2009: participation EQCP study baseline

inclusion of 20 COPD patiënts

survey on team-collaboration and group-dynamics

Spring 2010: developement and testing pathway

September 2010: official pathway kick off meeting with all

stakeholders

October 2010: start hospital COPD pathway follow-up

database at the ward

November 2010: EQCP post-test

Summer 2011: start tobaccologist activity

May 2012: COPD symposium presenting achieved goals

Spring 2013: start free information sessions for ambulatory

COPD patients and carers and start focus group

19

Mario Heirewegh


The COPD Pathway

Concept

Checklist:

control and communication tool for the team

base for systematic quality analysis

Education plan:

methodology used

evaluation of results: often repetition needed

20

Mario Heirewegh


The COPD Pathway

Concept

Patiënt Folder:

a “patient version” of the pathway:

patient is informed of the who, when and what

planned examinations/interventions

information leaflets

cover letter: what we aim our approach?

21

Mario Heirewegh


The COPD Pathway

Scientific Key Interventions

Designed as a checklist, which includes five sections,

with all key interventions during hospitalization that

certainly need to be addressed.

Medical

eg. the pulmonologist systematically examines whether

there is an indication for start of chronic oxygen therapy

at home

Education

eg. the physical therapist teaches the patient a correct

inhalation technique and sees to it daily

eg. professional smoking cessation counseling by an

approved tobaccologist

22

Mario Heirewegh


The COPD Pathway

Examinations

eg. ABG and lung function test at fixed intervals

Care planning

eg. systematic B.M.I. measurement , monitoring weight

and oxygen saturation → daily patient assesment

Medication

eg. → antibiotics only if strictly necessary based on

procalcitonin (= infection marker blood test)

eg. AB treatment as short as possible

eg. rapid transition to oral therapy

eg. reduction schedules for corticoids

23

Mario Heirewegh


The COPD Pathway

The education plan, where all team members

contribute, comprises the following items;

disease understanding

(terminology, diagnosis, prognosis…)

smoking cessation

(motivational techniques, tools…)

inhalation- and oxygen therapy (inhaler use…)

physical exercise/ breathing

exercises/rehabilitation (prevent muscle atrophy…)

nutritional advice (risk of malnutrition…)

prevention (influenza vaccination…)

discharge instructions (medication schedule…)

24

Mario Heirewegh


Together, with respect, for your

wellbeing!

Why this care vision?

Within the mission statement of the AZ Sint-Blasius, the team

developed a shared vision of care.

All members of the multidisciplinary treatment team COPD

endorse such a vision of care.

With this vision, we consider the patient and his relatives as

our first partner in the care process. These active partnership

that involves mutual commitments finally results in patient

empowerment also.

25

Mario Heirewegh



wellbeing!

"We are committed to work to improve, restore or longer

maintain health and well-being. Efficient in respectful

partnership with each care recipient and his or her family,

We want to achieve this goal together to form a high-

performance, multi-disciplinary team of which there is

appreciation for the input of all team members. We invest

all of our available resources, and our professional

expertise in team work. In this way we aim to

continuously optimize the quality of our total care. "

26

Mario Heirewegh


What makes this project innovative ? Fully evidence based

Keyinterventions from the European Quality of Care

Pathways study conducted by the Centre for Health

Services and Nursing Research of the University

Leuven commissioned by the European Pathway

Association. (Examines the effectiveness of a COPD

care pathway in acute hospitals.)

Multidisciplinary collaboration from a clearly defined

team vision

"Together, with respect, for your well-being.“

Investment in human resources.

Team + care recipient = extra value

27

Mario Heirewegh


What makes this project innovative ?

Patient empowerment due to an active

partnership with the patient and his relatives.

mutual commitment

Attention to a large but socially weaker and

often unsung, target with a current problem.

current prevention (smoking cessation) will affect the

incidence only in the longer term

28

Mario Heirewegh



Emphasis On Targeted Education

encouraging selfmanagement

active role for care recipient / relatives

Systematic monitoring and improvement

of the careproces →higher level of care quality.

database and clinical performance indicators

29

Mario Heirewegh



Positive effects on patient safety:

better coordinated care

shorter L.O.S.

better informed patients and relatives will report

(potential) incidents earlier than before

rational drug use:

oral instead of IV : risks of thrombophlebitis,

catheter sepsis ↓

AB en corticoïds: risks of AB resitence and side

effects ↓

30

Mario Heirewegh



Ambulatory Component

freely accessible, periodic, information sessions for

ambulatory patients and carer givers in collaboration

with the primary care (GP’s, homecare …)

involvement of patients in the organization of the care

process through focus groups

31

Mario Heirewegh


*Antibiotics: Augmentin, Avelox, Biclar, Ciproxine, Maxipime, Tazocin (cfr. former studies clinical pathway COPD).

Facts and figures

Baseline

october 2009 - march 2010 october 2010 - march 2011 october 2011 - march 2012 october 2012 - march 2013

# Admiss ions 93 81 89 62

# Readmiss ions <= 30 days 6 1 5 3

# Patient days 1069 724 806 507

Average length s tay hospita l (days) 11,49 8,94 9,06 8,2

Average readmiss ions length s tay hospita l (days) 21,7 6 10,6 9,3

# Patients with antibiotics 68 49 66 38

% 73,12 60,49 74,16 61,29

# units antibiotics* 1721 1027 1537 851

Antibiotics , DDD* 1185 584 1043 535

# Patients with corticosteroids 88 76 83 59

% 94,62 93,83 93,26 95,16

# mg cortisosteroids/patientday 56,13 23,09 34,84 40,77

32

Mario Heirewegh


Facts and figures

Downward trend

readmissions within

30 days after

discharge.

33

Mario Heirewegh


Facts and figures

The average LOS

currently decreased

with 3,29 days since

the start of the PW.

34

Mario Heirewegh


Facts and figures

Reduction in the

percentage of patients

receiving antibiotics

through stricter criteria.

35

Mario Heirewegh


Facts and figures

Currently the

corticosteroid use still

almost 28% less than in

the baseline, in spite of

the re-rising trend.

Reduction of the total #

mg corticosteroids per

patientday → steroid-

related side effects ↓

Shift from intravenous to

oral adminstration → safer

and more cost efficient.

36

Mario Heirewegh


Sincere thanks to the entire team for their

daily commitment.


wellbeing!

37

Mario Heirewegh


It’s a matter of breath or death !

Questions ?

[email protected]

heading towards a copd care pathway - scottish...

Documents