Step 1. Consider “WHY” change

Respiratory : Quality prescribing strategy - a guide for improvement
Scottish Government Effective Prescribing & Therapeutics Division
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Consider “WHY” change respiratory care?

Create conditions for change - consider the impact of respiratory conditions locally, using local and national data, related to new guidance.

 

Suggested actions

 

 

Incidence of Asthma and COPD

Consider the incidence and prevalence locally, at board, cluster and practice level. Does this vary with national and other local data?

 

Level of asthma and COPD care

  • How up to date are your annual reviews for asthma and COPD? Examine your practice level data.
  • How do you prioritise reviews for those most at risk? Are individuals reviewed within 48 hours after an exacerbation?

 

Outcomes for people living with respiratory conditions

  • What information has been given to people with respiratory conditions in your practice?  
  • How are you, as health care professionals, enabling people to live and die well with respiratory disease?
  • Consider the impact of better respiratory care on your patient outcomes. See Asthma UK video below
  • Focus on ‘What matters to the individual’ 
  • Poor care results in increased healthcare utilization: increased exacerbations and admissions. 

 

Cost of managing Asthma and COPD

Consider the cost of respiratory care to the individual and the board in managing these – personally, financially and resource involved? Can this be optimised?

  • Prescribing costs – PRISMs etc
  • DALYs etc PHO 

 

Environmental impact of respiratory care

Consider the environmental impact of respiratory care and take steps to reduce the carbon impacts for this, considering the co-benefits of improving environmental impact and improving respiratory care:

 

Consider factors to reduce/prevent long-term complications/manage co-morbidities

 

Identify “WHO” can support change in respiratory care?

Suggested actions

Think about your Guiding Coalition who can act as strategic facilitators and can link the work to the wider organisation priorities? 

Who will be in your core Improvement/implementation Team? This may include representatives of people living with respiratory conditions as well as colleagues from the multi-disciplinary team.

People and community assets

  • People living with respiratory conditions
  • Community link workers
  • Third sector agencies
  • Smoking cessation groups
  • Local community and council groups e.g. physical activity, walking, community singing (See ALISS for local groups)

Primary care/GP practice

  • Cluster quality leads
  • Practice quality lead
  • Clinical lead (in practice for respiratory)
  • Advanced Practitioners (Nursing and Allied Health Professionals)
  • General practice nurses
  • Healthcare assistants
  • Reception staff
  • Practice/office manager
  • Pharmacist/technician
  • Community pharmacy

Hospital/acute location

  • Care of Elderly/Medicines of elderly wards and staff
  • Respiratory wards
  • Acute admissions
  • Pharmacy department
  • Chest physiotherapy
  • Pulmonary rehabilitation team
  • Respiratory Technicians (PFTs)
  • Dietetics (Acute and community)

Specialism

  • Managed Care Network (MCN)
  • MCN manager
  • Respiratory specialist nurses
  • Specialist AHPs
  • Community respiratory team
  • Clinic managers

Consider how you will involve people living with respiratory conditions and wider stakeholder networks. Stakeholder analysis can help you identify who needs to be engaged and clarify the role they may play in your project e.g. people and community assets above, Local Formulary Groups, wider MDT (physiotherapists etc).

Create and communicate a clear vision by developing a communication and engagement plan to ensure stakeholders are kept informed and involved as you make changes.

  • Explain the benefits of changing respiratory care including prescribing – ensuring effective respiratory reviews, improved disease control, less inappropriate medication usage, lower environmental impact.
  • Acknowledge the challenges – reviews not taking place (patients attending, capacity), resistance to change, polypharmacy should be appropriate, patient/clinician perception of ‘good control’.

Return to image map 'Actions to support implementation'