statewide respiratory clinical network - queensland … · the purpose of the statewide respiratory...

Clinical Access and Redesign Unit

Statewide Respiratory Clinical Network

Operational Plan

2013 – 2014

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1. Purpose

The purpose of the Statewide Respiratory Clinical Network (SRCN) is to promote measurable improvements in respiratory care across Queensland.

This Operational Plan outlines the major work the SRCN will undertake between July 2013 and June 2014. The SRCN Steering Committee will review this Operational Plan if clinicians/consumers identify a significant change in priorities. This document will be updated annually or as work progresses.

2. Reporting Structure

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3. Statewide Respiratory Clinical Network Key Priority Areas

Priority

Are

a 1 Asthma

2 Chronic Obstructive Pulmonary Disease

3 Indigenous Respiratory Health

4 Lung Function Testing

5 Sleep Disorders

6 Smoking Cessation

4. Operational Plan

1. Asthma

Strategy Actions Person / Group

Responsible

Performance Target /

Expected Outcome

Timeframe Strategic / Quality Link

Improved availability of standardised quality asthma education to all patients with asthma regardless of location in Queensland and improved patient compliance with self-management of asthma.

1. Implement and complete Asthma DVD Project within allocated budget and timeframe and in collaboration with Asthma Foundation Queensland – production of an Asthma patient education DVD for use in Emergency Departments and other health facilities where there is limited or no access to a local Asthma Educator, with sufficient copies to distribute to appropriate health facilities.

Asthma Work Group

• Project completed with

Asthma DVD and project

completion report produced.

• Reduction in Emergency

Department presentations

with asthma.

• Improved availability of

standardized quality asthma

education to asthma patients.

2013-14 1. Asthma is a key target chronic disease of the Queensland Strategy for Chronic Disease 2008-2015.

2. National Asthma Strategy 2009-2013.

2. Collaborate with Queensland Asthma Foundation in the production of their Asthma Assist Pack for patients with asthma.

Asthma Foundation Queensland / Asthma Work Group

• Project completed and

Asthma Assist Pack resource

produced.

December 2013

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Responsible


Expected Outcome


3. Implement, monitor and evaluate CPIP Indicator: individualised action plan for people with asthma.

Asthma Work Group

• Demonstrated clinical

practice improvement in the

use of completed

individualised Asthma action

plans.

30/6/2013

4. Development of a standardised action plan that can be computer generated.

Asthma Work Group

• Standardised computer

generated asthma action plan

developed.

30/6/2012 and review

5. Develop a specific Asthma Emergency Department Discharge protocol and pack to reduce re-presentations and admissions to ED with acute uncontrolled asthma.

Asthma Foundation Queensland / Asthma Work Group

• Asthma Emergency

Department Discharge

protocol and pack including

an Asthma Interim Action

Plan, letter to GP, spacer,

referral to GP and Asthma

Information/Assist Pack and

DVD.

2013/14

2. COPD


Responsible


Expected Outcome


Develop and evaluate standardised decision support tools that improve outcomes for people with Chronic Obstructive Pulmonary Disease (COPD).

1. Formalize Pulmonary Rehabilitation

Data collection for benchmarking.

COPD Work Group

• Finalize Data collection on MARS for 6 months trial.

January 2014 for analysis.

COPD is a key target chronic disease of the Queensland Strategy for Chronic Disease 2008-2015.

2. Oxygen safety issues identified with oxymizer pendant (OP).

• Standard letter of

authorization to be faxed to

Oxygen suppliers to enable

patients to purchase device

and have OP test booked.

• Coordinators to keep and

hand over to the next person.

30/6/2012 and review

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Responsible


Expected Outcome


Assist in supporting via Australian Lung Foundation education DVD for their Chronic Lung Disease Self-Management Project covering topics patients have requested:-

• Managing Your Lung Condition (intro to self-management)

• How Do My Lungs Work? (structure and function of the respiratory system)

• Managing Your Breathlessness

• Managing Your Treatment Options (compliance)

• Questions I can ask My Health Professional (communication and confidence)

• Who is my Health Care Team? (what is a multidisciplinary team)

• Managing My Fatigue and Energy Conservation

• Tips for Looking after myself and my condition (physical health, emotional health)

• Benefits of Exercise Programs and Ongoing Support (what is pulmonary rehab, lungs in action, patient support groups)

• Supportive Care and End-Of Life Issues (palliative care, supportive care and legal issues)

• Statewide Coordinators

Pauline Hughes, David

McNamara and Colleen

McGoldrick currently

assisting in reading scripts

prior review/further

assistance by working group.

Filming completed and production of the DVD is in process.

30/6/2013

Mapping changes in the Pulmonary rehabilitation programs

Review proposed district changes to the programs and reporting them back to

Dr Zappala, Chair of the Respiratory forum.

The whole group

To enable this forum to advocate for these programs if they are against evidence based practices.

31/7/13

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3. Indigenous Respiratory Health


Responsible


Expected Outcome


Improve access to specialist respiratory services and health outcomes for Aboriginal and Torres Strait Islander peoples as well as continue to build community capacity to self-manage chronic respiratory illness through implementation and evaluation of the Indigenous Respiratory Outreach Care (IROC) Program.

1. Continue to implement and evaluate a model for providing culturally appropriate and acceptable adult and paediatric respiratory specialist outreach services to Aboriginal and Torres Strait Islander in rural, remote and urban communities.

IROC Program Team

• Service expanded to include

additional sites (3 adult and 3

paediatric sites) in

consultation with local Elders,

community members and

health service providers.

30 June 2014 and review

1. Fixing the gaps and improving the patient journey is a priority area of the COAG National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes.

2. Queensland Department of Health Making Tracks Policy and Accountability Framework.

2. Empower Aboriginal and Torres Strait Islander communities to engage as partners in respiratory health and service delivery.

IROC Program Team

• Key community members

and Elders are consulted with

and their approval sought

prior to implementation of any

respiratory outreach clinic,

research and/or training

within the local community.


3. Continue to develop, implement and evaluate a suite of innovative and culturally appropriate patient / community respiratory health education resources and communication tools that target those Aboriginal and Torres Strait Islander people with low literacy skills and/or English is not their first language, in partnership with internal groups and external organisations.

IROC Program Team

• A suite of respiratory health

resources and

communication tools that are

culturally and educationally

appropriate for Aboriginal

and Torres Strait Islander

peoples are produced and

implemented.

• Other resources developed,

implemented and evaluated

in response to need identified

by local communities, health

workers and health service

providers as required.


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Responsible


Expected Outcome


4. Develop, implement and evaluate training resources / programs for Indigenous Health Workers and other health workers that are culturally appropriate.

IROC Program Team

• Indigenous asthma training

program piloted in

partnership with Asthma

Foundation Queensland.

• Indigenous Spirometry

Training Program

implemented in partnership

with the Network’s Lung

Function Testing Work

Group.


5. Continue to implement the Aboriginal Knowledge, Attitudes and Perception of Respiratory Illnesses (AKAPRI) research study.

IROC Program Team

• Research study is

implemented and evaluated

in accordance with

nominated research project

timeframes.


6. Implement the Lung cancer in Indigenous communities in rural and remote Queensland project.

IROC Program Team

• Local patient pathway for

Aboriginal and Torres Strait

Islander people requiring

treatment of lung cancer

through primary, secondary

and tertiary care is mapped.

• Culturally appropriate lung

cancer patient education

resource developed.

• Indigenous lung cancer

training resource developed

for Indigenous Health

Workers and other health

professionals.

• Project deliverables

submitted to Cancer Australia

in accordance with

nominated project timeframes.


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Responsible


Expected Outcome


7. Explore, develop and implement initiatives that encourage and support innovative, culturally and educationally appropriate community learning in relation to respiratory health (e.g. mobile learning, social media and traditional communication) for Aboriginal and Torres Strait Islander peoples.

IROC Program Team

• IROC Program’s

Communication and

Marketing Plan is

implemented.

• IROC Program’s mobile

iLearn initiative is

implemented and evaluated.

• The IROC Program

participates in at least 3

community events with an

interactive information stall.


8. Upskill local health service providers in the area of respiratory health to improve respiratory health outcomes for Aboriginal and Torres Strait Islander peoples in Queensland.

IROC Program Team

• Onsite respiratory health

information sessions / training

/ case discussions provided

to Indigenous Health Workers

and other local health

professionals on request.


9. Cooperate, collaborate and communicate with IROC Program partners to best meet agreed respiratory health needs of Aboriginal and Torres Strait Islander peoples.

IROC Program Team

• Respiratory outreach clinics,

research and training are

implemented and resources

are developed in partnership

with key stakeholders.


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4. Lung Function Testing


Responsible


Expected Outcome


1. Provision of culturally appropriate spirometry training programs for Indigenous health workers and other health professionals.

1. Continue provision of the Indigenous Health Worker (IHW) Spirometry Training Program (in conjunction with the IROC Program) within allocated budget and timeframe.

Lung Function Testing Work Group

• 8 2-day workshops targeting approximately 80 Indigenous Health Workers delivered

• Increased use and quality of spirometry amongst Indigenous communities.

30 June 2014 1. Spirometry is the Gold Standard test for diagnosis and assessment of COPD.

2. Spirometry is the internationally recommended test to establish a diagnosis of Asthma.

3. Spirometry Training Courses: A Position Paper of the ANZSRS and TSANZ (Feb, 2004).

2. Develop a plan for long-term sustainability of the IHW Spirometry Training Program via provision through the Cunningham Centre (QH Registered Training Organisation).

• Program included in suite of training courses offered by Cunningham Centre.

30 June 2014

3. Roll out the QH Spirometry Training Program for other health professionals in collaboration with the Cunningham Centre.

• Agreement with Cunningham Centre for provision of course.

• Cohort of accredited trainers identified for course delivery

• 5 courses delivered.

30 December 2013 30 June 2014

2. Promote quality in spirometric practice throughout Queensland

4. Develop an education program promoting adoption/implementation of the Global Lungs Initiative (GLI) all-age reference values across health care in Queensland.

Lung Function Testing Work Group

• GLI reference values adopted by a majority of practices.

30 June 2014 Multi-ethnic reference values for spirometry for the 3-95 year age range: the global lung function 2012 equations. Eur Respir J 2012; 40: 1324–1343.

5. Pursue funding opportunities to conduct reference value research project in Qld Aboriginal & Torres Strait Island communities to validate GLI reference values for Indigenous people.

• Funding secured for research project.

• Timeline established for conduct of study.

• Study completion.

30 June 2014 30 June 2016

3. Standardisation of approach to cardiopulmonary exercise testing (CPET) including reporting format and interpretation.

6. Finalise development of a standardised CPET guideline, including incorporation of feedback from key stakeholders.

Cardio-Pulmonary Exercise Testing Sub-Group / Lung Function Testing Work Group

• Standardised CPET guideline produced.

30 June 2014 Cardiopulmonary exercise testing is the gold standard for evaluation of global cardiopulmonary function. 7. Initiate a multi-centre predicted

reference value validation study. • Multi-centre predicted reference

value validation study initiated.

30 June 2014

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5. Sleep Disorders


Responsible


Expected Outcome


Queensland Sleep Disorders Program provides scope, direction, practice standards and disadvantaged patient therapy equipment management.

New subcommittees and working groups report to the Program Executive to then provide advice to the Network on relevant service issues.

Sleep Sub-committees and Working

Groups are now established within

Queensland Sleep Disorders Program.

The Quality and Standards Committee will focus, on clinical practice performance indicators, quality and safety and best practice initiatives. The Equipment Committee will identify and evaluate technology and standing offer arrangements. The Clinical Committee addresses approval of complex equipment and guidelines and processes for equipment allocation.

QSDP

New committee structure and working groups are able to effectively achieve desired progress towards priority projects.

Initial discussions.

Timeframes to be determined by QHSDP executive at subsequent meetings

Establishment of clinical networks is a key initiative of Queensland Health to engage clinicians in decision making about clinical services planning and implementation, clinical practice improvement and quality and safety.

Development of state wide sleep service Key Performance Indicators.

Proposed KPIs have been reviewed by executive of QSDP.

Agreed KPIs include:

• Patient satisfaction survey.

• Epworth Sleepiness Scale change post treatment where relevant.

• Therapy adherence through mean use hours.

• Waiting time from date referral received to offer of appointment within each urgency category 1, 2 and 3.

SDP Quality and Standards Committee

Patient Satisfaction Survey has been developed, reviewed and being trialled at TPCH. KPIs require standard measurement and calculation criteria which are to be established,

KPI routine collection by 30 December 2013

Develop agreed clinical pathways for major sleep disorders. Initially OSAHS and disorders requiring NIV.

Progress through QHSDP Quality and Standards Committee.

QSDP S&Q Committee

Survey services and clinicians for proposal feedback. Develop proposal for further consultation at other sleep forums.

Initial discussions. Target 30

December

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Responsible


Expected Outcome


Item for discussion at Statewide Sleep Disorders Program Executive to establish targets and expected outcomes.

2013

Proposal to develop invasive ventilation services at major metropolitan sleep services.

PAH Sleep Service best placed to provide this service. Complex issues to review Queensland Sleep Disorders Program. Local issues may limit the option for some centres.

QSDP /

Craig Hukins

Develop proposal and identify barriers to establishing a dedicated service at the PAH. Item for discussion at Statewide Sleep Disorders Program Executive.

Initial discussions.

Timeframes to be determined at subsequent meetings

Patient access.

6. Smoking Cessation


Responsible


Expected Outcome


1. Improvement and standardisation of frontline clinical approach and process of addressing nicotine addiction in Queensland.

Promote smoking cessation clinical pathway and associated decision support tools such as the smoking free action plan.

Smoking Cessation and Tobacco Control Work Group

Ensure smoking cessation clinical pathway and associated decision support tools are available on the respiratory network page.

2013-14 1. Quitting smoking is a

Queensland

Government 2020

target.

2. Tackling smoking is an

Indigenous Health

National Partnership

agreement priority

area.

3. Is a priority area of the

Queensland Health

Strategic Plan 2012-

2016.

Demonstrated clinical practice improvement in smoking cessation counselling, provision of NRT and improved smoking cessation abstinence rates.

2014

2. Increase knowledge of health professionals providing advice and care to people who smoke and who have a nicotine addiction.

Release and promote the smoking cessation training DVD

Evaluate the smoking cessation DVD

Development of evaluation tool. 2014

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Responsible


Expected Outcome


Explore and seek support and funding for development of a smoking cessation and nicotine dependence training program for health professionals statewide.

Deliver smoking cessation training for healthcare professionals.

2013-14 4. Reducing smoking

prevalence is a key

objective of the

Queensland Strategy

for Chronic Disease

2005-2015.

5. Smoking cessation

and improving the

quality of, and access

to, services and

treatment for smokers

are priority areas of

the National Tobacco

Strategy 2004-2009:

The Strategy.

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