The Non-Invasive Ventilation (NIV) project
The Non-Invasive Ventilation (NIV) project team improved quality of care for patients with acute Chronic Obstructive Pulmonary Disease (COPD) who receive NIV. This was achieved by gaining an understanding of patient/carer and staff perceptions of NIV care and implementing key recommendations from evidence-based resources.
Guidelines suggest that when patients are started on NIV, there should be a clear plan covering what to do in the event of deterioration and ceilings of therapy should be agreed. NIV’s benefits and limitations should be explained so that if it is ever necessary in the future patients will be aware of these issues.
At St Marys hospital, during project period, NIV episodes where a clear plan was followed increased from 50% to 76% and ceiling of care discussions improved from 77% to 89%. It is well recognised that patients with COPD should be made aware of the technique of NIV. To address this, the team developed two videos, one for clinicians caring for patients on NIV and another for patients/carers explaining why NIV is used and what to expect. Patient experience feedback during the project included positive comments on communication and information provision.
This work is leading the translation of NIV evidence-based guidelines into practice and demonstrates tangible benefits. The project team now serve on a committee developing a BTS endorsed quality improvement (QI) tool and help other trusts improve their NIV service. Clinical collaboration is ongoing with three other trusts and the University of East Anglia to develop the patient experience work further.
Contribution of CLAHRC North West London
CLAHRC NWL provided funding and a platform for change of NIV services within Imperial College Health Trust by facilitating the use of our systematic approach to improvement using QI methods. This enabled the team to arrive at a collective aim, engage staff and patients, and use tests of change to implement the NIV bundle and other interventions.
We supported the use of measurement for improvement to identify key areas to improve implementation of guidelines i.e. NIV treatment in a designated area, ceiling of care decision and discussion, optical medical management of NIV, and NIV parameter plan being documented and followed.
What happened next?
There is a lack of research into the use of patient experience to drive projects within NIV care, which inspired this project. By completing this project, the team have improved the service for patients at ICHT and plan to share this work more widely for other trusts to use as a model for improvement.
Next steps are to achieve sustainability and manage spread of the project to neighbouring acute sites. This project has demonstrated how effective use of collaboration, engagement and QI tools can enhance the quality of NIV care at ICHT.