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Tuesday 16 June 2015

NRAD report - Delivering Excellence Locally - What changes have you made?


Delivering Excellence Locally
Practice Nurse is inspired to improve asthma care after reading NRAD report
Francesca Robinson talks to Sarah Anderson, Respiratory Leader, Yorkshire
Featuring initiatives led by PCRS-UK members around the UK, supported by PCRS-UK programmes and tools

A practice nurse, who recently joined the PCRS-UK Clinical Leadership Programme, has launched a series of changes to improve asthma care in her practice after reading the National Review of Asthma Deaths (NRAD) report.
“You can't read a report like that and then not do anything about it, I would not have been able to sleep at night,” says Sarah Anderson, who is respiratory lead for her Leeds practice.
“When the report came out a year ago I realised it needed action. I started to question my own practice and started thinking about the wider picture and what we could do to improve the care we provide for over 800 people with asthma in this practice.”
First Sarah gave a presentation to her GPs who were surprised when they heard about the findings and recommendations of the report.
Then she printed out a list of patients who had received more than 12 prescriptions of salbutamol in a 12 month period – some had had more than 36 inhaler issues in that time. She called in the patients on this list that she felt were having problems with their asthma control. She reviewed them and educated them on using their inhalers after finding that many were unsure how they worked.
“If the patient’s compliance is poor I explain to them about the NRAD report and its findings. Often they are quite surprised and tell me they didn’t realise people still died as a result of having asthma. I’ve noticed this knowledge has increased their compliance. Some patients are now coming in more regularly if they are not feeling so well – before they just used to wait until their annual review,” says Sarah.
Nurses in the practice were using different asthma action plans so Sarah has now standardised this, recommending that everyone uses the Asthma UK Action Plan. She has inserted a link to the plan into the asthma template.
Sarah has also worked to improve communications between the prac- tice and secondary care to speed up the process of receiving docu- ments after patients have been to accident and emergency (A&E) and have been admitted to hospital following an exacerbation. Now the practice admin team sends her a note informing her when a patient has been discharged so they can be followed up within 48 hours.
Sarah has also disseminated information about the NRAD report and shared the changes she has made in her own practice with the PCRS- UK affiliated Leeds Respiratory Network, she set up in 2013 with colleague Melissa Canavan.
She works only three days a week in her practice and has had to find the time to make these changes mainly by snatching ten minutes here and there in between patient appointments.
“You could spend all day every day sorting out respiratory issues but unfortunately as a practice nurse I can’t spend all my time doing this. It is very rewarding to be able to make the changes and see the care of patients improve. In time we will need to audit the process”.
“It has also been exciting to see the enthusiasm and passion for im- proving asthma care that has been rubbing off among colleagues in the Respiratory Network which has been expanding rapidly since we set it up in October 2013,” says Sarah. 

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