Authors (including presenting author) :
Lit PKM (1), Ng SW (1), Tai CE (1), Chan YHG (1), Chow, MC (1), Li CM (1), Chui HC (1), Ng PK (1), Cheng KL (1), Lee YM (1), Li CML (1), Mak KM (1), Lau KYR (1), Pong CY (1), Cheng KF (1), Ho YK (2), Wong SKS (2), Leung SLE (2), Lam KCH (3)
Affiliation :
(1)Specialty Advisory Group (SAG) (Respiratory) 2019, Hospital Authority (2)Department of Medicine and Geriatrics (3)Advisor of Specialty Advisory Group (Respiratory), Hospital Authority
Introduction :
New COPD patient numbers were 51000 but also 51000 numbers died yearly since 2014. Unplanned re-admissions rate in medicine were common with 17.9% in 2017 and resulted in increased use of hospital beds and days, thus a huge health cost impact to local healthcare system. An Evidence Based Practice- Bundle care to prevent COPD unplanned readmission rate programme was implemented to align with strategic plan of “standard of care of COPD” from Central Committee on COPD.
Objectives :
1.To evaluate the effectiveness in reduction of length of stay (LOS) & unplanned admission or hospital readmission 2.To standardize the practice of advanced nursing care by formulation of COPD Care Bundle Guideline in SAG (Respiratory)
Methodology :
The COPD bundle care Model includes 7 elements: 1. Inhaler technique assessment and education, 2. Smoke cessation counseling, 3. follow-Up in Nurse clinic after discharge in 2 weeks and regular intervals 4. Self-home plan management 5. Pulmonary Rehabilitation Programme (PRP) referral, 6. Phone follow-Up within 72 hours upon discharge, then week 4 and 8 after discharge 7. Help-line access for patient enquiry on shortness of breath and self-home plan management, fast track access to nurse and doctor’s clinic appointment. It was a multi-centered prospective study which was carried out in November 2019 to April 2021. Patients with COPD exacerbation admitted in medicine & Geriatric ward from 14 hospitals with smoking history and FEV1 <70% were recruited. Those patients who were old-aged home resident, with diagnosis of lung cancer, acute pulmonary oedema, congestive heart failure, or on home non-invasive therapy, with cognitive impairment or being recruited in Integrated Care Model Programme were all excluded. Programme was initiated during hospitalization. Spirometry parameter, symptoms scores-CAT, demographic data, inhaler technique and drug adherence scores, exacerbation & readmission numbers were obtained before and after the programme one to three-months. A standardized phone follow-up record template including assessment and monitoring with nursing interventions was adopted from PWH with permission. Disease management education, inhaler technique correction with returned-demonstration, drug adherence, smoking status and Long-Term Oxygen Therapy were reviewed and re-educated. Self-home management interventions would be reiterated and assisted to practice the skills, guide changes in health behavior and provide emotional support.
Result & Outcome :
There were 94 COPD patients in which 91 were Male and 3 were female ( mean age 74.6 vs.73). The EBP COPD bundle care programme had successfully shorten the average length of stay -1.782 Days, (P <0.005), improved marginal mean (95%CI) of CAT symptom scores from 16.32 vs.12.42 (-3.9), marked improvement in inhalers scores (48.6 vs 60.6 P<0.005) and knowledge (5.76 vs. 6.43 P<0.005). Both AED attendance and unplanned admission had markedly reduced to -18% & -24.5% 3-months after discharge respectively. (P <0.05). Inhaler adherence improved 38.5% after last visit follow-up in nurse clinic. (P<0.05) In conclusion EBP-COPD bundle care with 7 elements adoption can reduce length of stay of hospitalization, unplanned readmission and retention of knowledge, improve inhalers technique and drug adherence.
