Implementing change is not limited to one person/role.  Everyone involved in the care of those with respiratory disease has a role.  However, change ideas need to be tested to determine what works well and is sustainable.

Suggested actions - testing changes

• Once you have decided on your change(s) and actions, there are tools to help test and review the impact of the change(s)
  • Cause and effect analysis 
  • SWOT analysis
• There may be more than one change required. A change idea is not just a general concept. For example, improve communication in the team is a concept whereas the introduction of a weekly huddle is a change idea.
• Start small, you don’t have to address all the changes that you think are necessary all at once.

Use the Plan Do Study Act (PDSA) cycles to test ideas of change and assess its impact

Examples of tests of change:

• SUSQI report - Incorporating decarbonisation into pharmacist-led asthma clinics
• Medicines Optimisation Team SusQI project report - Reducing the inhaler blues
• SusQI project report - Turning blue inhalers green
• Sustainability and Quality Improvement | Turas | Learn (nhs.scot)

Regular medication review is essential to ensure all medication continues to be appropriate and any changes in clinical conditions are managed appropriately.  The 7-Steps medication review process improves clinical outcomes and reduces harm. Medication review can be planned or ad hoc and will often depend on the setting and service user group.

Consider the review process and the 7-Steps medication review

Current guidance

• Quality prescribing for respiratory guidance
• Manage Medicines app

Training and case studies

• Case studies in guidance: Quality prescribing for respiratory guidance
• Polypharmacy guidance including 7-Steps medication review process, this includes a template for a 7-step medicine review 
• Evidence based polypharmacy reviews and the 7-Steps process (CPD accredited online training on Turas) 
• Turas Shared decision making
• Chronic obstructive pulmonary disease (COPD) | Turas | Learn (nhs.scot)
• Asthma | Turas | Learn (nhs.scot)

Consider the location

• The location of the review will determine the type of review (ad hoc or planned); staff involved; preparation required (e.g. bloods, measurements); single disease or polypharmacy.
• Ensure follow-up

• Planned – acute setting: Respiratory clinic – focus on asthma and COPD. May not include other co-morbidities.
• Planned – primary care: Respiratory clinic or all chronic disease management. Practice preference.  
• Utilise all team members – practice/office manager (identification/prioritisation); reception team (organise appointments); healthcare assistant/health care support worker/CTAC (bloods (if necessary) and measurements); general practice nurse/practice pharmacist/GP (medication review); general practice nurse (long term condition review).
• Ad hoc/ Unplanned care – acute setting: During acute admission for asthma or COPD exacerbations or unrelated event.
• Ad hoc/Unplanned care – primary care: When other change in medication occurring; acute condition/minor illness, e.g. acute infection or after transitions in care settings or in Out of Hours.