COPD Bundle—A1 | Diabetic Foot—B1 | |
---|---|---|
Duration | 04/09- 09/10 | 04/11- 09/12 |
Site | Hospital A | Hospital B |
Implementation team | Respiratory consultants, clinical nurse specialists, pharmacist, patient advisor, physiotherapist, smoking cessation specialist, project manager (nurse) and QI advisors | Endocrinology consultants, patient advisors, podiatrist ward/specialist nurses, project manager (nurse), research nurse and QI advisorsa |
Resources for implementation | £100,000 | £100,000 |
Evidence-base for bundle | National Institute for Health and Clinical Excellence Clinical guideline 101 (2010) [14] | Diabetes UK Guidelines (2011) and National Institute for Health and Clinical Excellence Clinical guideline 119 (2011) [15, 16] |
Defined patient group/segment | Patients admitted to hospital due to an acute exacerbation of COPD | Patients admitted to hospital for any reason with known diabetes |
Care setting | Acute medical unit/ward | Acute medical unit/ward |
Time to deliver bundle | During admission | During admission |
Outcomes to be improved | Reduced readmission to hospital and in hospital mortality | Reduced readmission to hospital and complication of diabetic foot including amputation |
Care bundle elements | COPD Bundle for acute exacerbation • Respiratory nurse notified of admission • Smokers offered smoking cessation assistance • Referral to pulmonary rehabilitation for assessment • Provision of written information about COPD • Assessment and demonstration of satisfactory inhaler use • Follow-up appointment with specialist | Diabetic foot bundle • Presence or absence of Ulcers • Presence or absence of infection (Fever, Low BP, Red and/or warm foot, pain without trauma) • Presence or absence of ischaemia (Absent foot pulses, Cold or gangrenous foot) • Presence or absence of deformity [Charcot Foot] (Foot does not look normal) Positive result- manage appropriately |
Impact (during initiative) | Care bundle delivered to ≥ 90% of patients | 900 patients screened in the first 12 months b |
Sustainability (After initiative) | Continued implementation of care bundle | Modified assessment used by surgical team |
Diffusion | Care bundle by numerous NHS acute hospital trusts throughout England, supported by CQUIN payments | Clinical lead left the hospital and was continued by surgical lead |