April 2007 marked a significant change for Blackburn with Darwen tPCT (BwD). It was the start of an innovative approach to training and education for practice nurses (PNs) and healthcare assistants (HCAs), one which has had significant results in a relatively short time and can be adapted and rolled out for other long-term conditions.
BwD has some of the worst health statistics both regionally and nationally. It is the 17th most deprived local authority area and life expectancy is on average eight years lower than anywhere else in the country. Evidence suggests that smokers from disadvantaged areas are more likely to start smoking as a coping mechanism and therefore find it harder to quit. Smoking contributes 80% towards all cases of COPD.
BwD tPCT has a registered population of 164,500 and at the start of the programme 3,148 patients on the COPD register, which equated to 1.91% (the national average being 1.4%). COPD needed to be tackled head on.
The objectives of the COPD care programme were to improve healthcare for COPD patients by:
BwD tPCT had no structured education programme for PNs and HCAs - training offered in the area of COPD was through the COPD Local Enhanced Service (LES) launched in 2006, which consisted of academic courses at diploma level. Sign-up to the COPD LES was only 55% due to many of the PNs not being in a position to undertake this level of education and wanting a more "hands-on" approach.
To tackle this BwD tPCT employed an independent training provider and respiratory nurse consultant, who could provide RCN accredited education. A proposal was submitted to the PBC Board and PEC for approval to commence a specific competency-based pilot with this training provider and one pharmaceutical company. The components of the project were already there, it met the strategic needs of the tPCT, and ensured that equity and a consistent message would be given to all practices.
Since implementation of the programme the COPD register has increased from 3,148 to 3,257, 1.91% to 1.98%, an increase of 3.7%. However, the local acute trust has reported a decrease in referrals, exacerbations and admissions.
In addition a practice nurse forum has been formed along with a COPD patient group run by one of the PNs. There have been reports of more robust working relationships between primary and secondary care, resulting in the offer of job shadowing by the respiratory team based within in the acute trust for PNs
Five HCAs have started undertaking patient reviews for mild COPD patients to increase the capacity of the PN appointments to undertake patient reviews for those categorised as moderate and severe.
The Head of Medicines Management and New Drugs Pharmacist for East Lancashire were invited to a PN educational session where they were presented with a protocol written by the PNs for the discontinuation of Combivent®. This was endorsed by Medicines Management and subsequently rolled out across East Lancashire with recognition given to the PNs who had worked on this.
In fact the programme has proved such a success that it has been shared with other PCTS, the LHB in North Wales and students at Bolton University through presentations, teleconferences and meetings.
The PNs involved have found the process very satisfying. As one put it: "Since starting this course the practice has gone from 82 patients on the register to 98, all diagnosed or picked up by me through opportunistic cases or asthmatics that are wrongly diagnosed. I also feel much more confident educating them and evaluating their care and treatment."
Project Lead, Ruth Rollings, sums up the team's success: "This programme has demonstrated that by working as a cohesive group it has been possible to make significant changes to the healthcare provided to patients with COPD. It has also provided the evidence to obtain funding for future training programmes for other long-term conditions."
The Nursing in Practice Awards 2008rewards best practice in a variety of clinical areas, and are designedto recognise excellence and innovation in the primary care setting.
As a nonprofit-making charity it is in a uniqueposition in that it is the only organisation within the UK that isspecifically focused upon the design, development and delivery ofrespiratory-related education. Their ultimate aim is to providepractitioners with the knowledge and skills to inform practice andeffectively improve patient care. As such their interprofessionaltraining and education programmes are designed and delivered to supportall levels of practitioner and are provided to meet the needs of bothindividuals and trusts and thus support service design and developmentwithin the NHS.
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