1. Blaenau Gwent Local Health Board Sharing Best Practice Oxygen Therapy Assessment for Patients with COPD Coral Wood Service Improvement Lead Respiratory Disease

2. Overview Key Strategic Drivers Background/Local Context Underpinning Principles/Priorities Progress to date Future

3. Key Strategic Drivers Designed for Life Wanless Local Action Plan Long Term Conditions Strategy British Thoracic Society Guidelines British Lung Foundation Welsh Health Circular 2007 - 063

4. Background/Local Context Meet with Welsh Assembly Government 2005- announced modernisation of Home Oxygen Service New Oxygen supplier Contractor had been appointed HOOF Form produced in draft Assessments had to be completed by a Respiratory Consultant

5. Underlying Principles All oxygen assessments completed by Feb 2006 Required to identify all patients receiving cylinder oxygen Oxygen concentrator patients already identified Improve clinical assessment and care for patients receiving oxygen at home Get high level sign up from LHB Chief Executive and Trust – Consultant Clinical Champion, Service Improvement Lead Appropriate support and treatment plan – thus preventing avoidable admissions Implement Best Practice Guidance - required every patient to be assessed

6. Patient Identification Visited every GP practice and local chemist (19) 340 patients identified on cylinder oxygen (£34.50 per cylinder 12-16 per week) Identified those known to respiratory service Confirmed diagnosis (blood gas analysis) Prioritised high users of oxygen first Appointments sent inviting them to clinic Held 3 nurse led clinic + 1 consultant clinic from October 2006 –January 2007

7. Results Reduced patients requiring oxygen therapy based on clinical assessment from 340 to 120 60 patients were known to respiratory Team 60 patients were cardiac in origin- trigged response by cardiologist Onward referrals made to a variety of diagnostic services

8. Results All patients were consented – data protection Clinical Assessments meant improved outcomes – Litres of oxygen – Correct length of time – Carbon Dioxide Retainers – dangerous position – Prevent inappropriate prescribing – Closer working with Palliative care Services

9. Where Are We Now Early and appropriate referrals (2 weeks) No waiting lists ( previously 8 months) Developed hand held record Developed and piloted ICP for Oxygen Assessment Developed Clinical Assessment and Home Risk Assessment Fully equipped clinic facility – demonstration aid Incorporated Smoking Cessation Clinic – unique to Blaenau Gwent Implemented a referral system to District Nursing Identified nurse with special interest in each district nursing locality All GP, D/N, Hospice supplied with pulse oximeters Arrange holiday oxygen

10. Future Continue to work in partnership to improve practice Secured funding stream identified from WAG Undertake Audit of Service for WAG Roll out ICP across patch

11. Blaenau Gwent Health and Social Care Service Model Maintaining Health and Well Being Managing Long Term Conditions Intermediate Health and Social Care Blaenau Gwent Hospital Acute Services Tertiary Services

12. Health and Social Care Model HEALTHHEALTHHEALTH Group 1Group 2Group 3 SOCIAL CARESOCIAL CARESOCIAL CARE Increasing Dependency