Implementing the Respiratory Health and Wellbeing Service Framework Through the Development of Nurses and Midwives Angela Drury Senior Professional Officer, NIPEC

What is a Service Framework? Focus on Service Users and Carers Set Clear Evidence Informed Standards Aim? Improve health and well-being Reduce variation and inequalities in treatment and care Link public health with safe and effective care

Patient/ client Pathway Template Prevention / Promotion Protection /Lifestyle Treatment Ongoing Care / Chronic Disease Management End of Life Care / Palliative Care Assessment & Diagnosis

Overarching Standard All people suspected of having COPD should have accurate assessment, diagnosis and management in Primary Care. Rationale COPD should be prevented where possible, but, as a minimum, disease progression should be slowed down or avoided by early diagnosis and optimal management in keeping with the most up to date evidence based guidelines. Evidence  National Institute for Clinical Excellence (2004) Management of chronic obstructive pulmonary disease in adults in primary and secondary care. National Institute of Clinical Excellence: London  Strategic Framework for Respiratory Conditions (N. Ireland), Responsibility for delivery / implementation HSC Trusts Primary Care Quality Dimension 1.All patients older than 35 years, with past/present smoking history, and presenting with exertional breathlessness, chronic cough, regular sputum production, frequent winter bronchitis or wheeze should have spirometry performed. 2.All patients with a diagnosis of COPD should have an assessment and review according to NICE guidelines 3.All patients suspected of or diagnosed with COPD should have their smoking history recorded and be given appropriate advice about smoking cessation and specialist smoking cessation services. Performance IndicatorData SourceExpected Performance Level Date to be achieved by Percentage of patients with COPD who smoke, who have had appropriate smoking advice DES Data set Audit of GP records 60% 80% 90% March 2010 March 2011 March 2012 Percentage of patients with COPD who are assessed, diagnosed and managed according to NICE Guidelines in primary care. DES dataset Rolling audit of GP records 60% 80% 90% March 2010 March 2011 March 2012

Current Work Cardiovascular Disease Respiratory Wellbeing Cancer Mental Health Learning Disability Spring 2009 May/ June 2009 Summer2009

Project Aims – To Produce: 1. A strategy to support the learning and development of nurses (and midwives) 2. A framework to support competency development …..in order to assist the implementation of the Asthma and COPD RHWSF standards.

June 2007 Asked by RHWSF Steering Group to assist production of L&D Strategy January 2008 Steering Group Appointment PM Learning Needs Workshop February 2008 Expert Working Group May 2008 May – June 2008 Development of Competency Framework/ Strategy June 2008 Consultation Workshop Publication of Strategy and R-CAT November 2008 October 2007 FundingCNO SG18/4/08 SG21/7/08 SG25/1/08

Need to do better? COPD Need to do better? Asthma Not do at all? COPD Not do at all? Asthma Tier 1 Tier 2 Tier 3

Core Learning And Development 1.Holistic assessment and diagnosis 2.Management and monitoring of chronic relapsing respiratory disease (asthma and COPD) 3.Communication 4.Patient education and enhancing self-management Assessment and Monitoring Activities 1.Pulse oximetry 2.Arterial Blood Gases 3.Peak Expiratory Flow Rates 4.Pulmonary Function Testing 5.Telehealth 6.Allergy testing Technological Interventions 1.Inhalers 2.Nebulisers 3.Oxygen therapy 4.Non-Invasive Ventilation Health Promotion 1.Smoking Cessation/ prevention 2.Exercise and Pulmonary rehabilitation

How can the R-CAT help nurses and midwives to implement the RHWSF standards?

Through….. Appraisal Revalidation ProfessionalSupervision NewServiceDevelopment ContinualProfessionalDevelopment PDPProduction Induction Learning needs analysis The building blocks of competence and quality service provision

Appraisal Revalidation ProfessionalSupervision NewServiceDevelopment ContinualProfessionalDevelopment PDPProduction Induction Learning Learning needs analysis needs analysis Education Commissioning/ Curriculum Planning

1. Select the appropriate Tier of Practice

2. Self-assess….. 1.Needs a lot of development 2.Needs some development 3.Is well developed

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Identify what it is you need to learn and develop Draw up an action plan of how you will do this with a colleague or supervisor Take small chunks of learning in 6-8 weekly cycles

Assessment and Monitoring Activities (6) Technological Interventions (4) Health Promotion (2) Core Learning and Development(4)

So then what? 3. Work through 4 core domains first - Small bites of learning - Flexible learning activities 4. Choose from the supplementary domains Link to …….