Leading Change

A general practice nurse (GPN), as the lead for asthma and chronic obstructive pulmonary disease (COPD) in her Northumberland general practice recognised an opportunity to improve patient outcomes by addressing unwarranted variation in practice.

Where to look

Evidence available nationally suggests that patients with self-care management plans in both COPD and asthma have better health outcomes and fewer A&E admissions for asthma and COPD exacerbations. Following training for level 6 COPD and asthma care, the practice nurse recognised the unwarranted variation between best and current practice within her GP surgery and addressed this by changing how their respiratory conditions were managed with more focus on patient empowerment and self-management, which is having a positive effect on patients.

What to change

The nurse reviewed current practice within the surgery and identified opportunities to introduce asthma management plans pre- and post- spirometry practices for reversing diagnosis of asthma and COPD and opportunities to improve asthma reviews and medicines management – including checking for patients’ potential over-use of short acting beta2-agonists (SABA) inhalers. By bringing in these changes she expected to see improvements in patient outcomes, increased empowerment in the practices of patients and reduce the number of missed appointments they were experiencing.

How to change

The GPN developed a COPD self-management plan and introduced the Asthma UK action plan for patients in the practice. The resources were posted out to patients prior to appointment so that it could be completed at home and were engaged and prepared for their next visit to the surgery.

The practice nurse adapted the way asthma reviews were conducted including the templates to record the data collected so they followed best practice. She also introduced asthma control test (ACT) scores for both adults and children attending all reviews. This has enabled patients to assess whether their asthma is controlled or not and helps to address SABA over-use.

Adding value

The full impact of the changes is still being assessed however, early signs are encouraging.

• Better outcomes – The new self-care managed approach and associated reviews are ensuring that patients’ asthma remains well controlled and this will continue to be monitored as the programme continues.
• Better experience – Asthma and COPD patients are experiencing more robust, evidence based reviews and are now empowered to identify when their condition is not controlled and seek appropriate support. Patients also show a better understanding of medicines use including the implications of overuse of salbutamol inhalers as this can increase the risk of asthma attacks.
• Better use of resources – There has been an increase in patients attending the surgery for assessment or treatment and the number of patients being seen promptly after any A&E admission has increased. The impact of the changes on A&E admissions for asthma or COPD exacerbations will be monitored but national evidence consistently demonstrates that similar actions taken to those in this practice have demonstrably reduced A&E admissions for asthma and COPD exacerbations.

Challenges and lessons learnt

This experience has highlighted the importance of current training and keeping up with guidelines so that nurses can develop clinical practice to improve patient outcomes. Overall, patients have engaged well, although it was a challenge at first to get all key stakeholders on board and understand the need for a change in asthma reviews and including the documentation side of the programme, as existing practice had been in place for a long time.

Find out more

For more information contact:

• Lisa Watson, Practice Nurse, Priory medical, North Shields, Tyne and Wear lisa.watson10@nhs.net