QI

Allowing you to achieve incremental and measurable changes to make a real difference to patients

Providing High-Value Care

Pulmonary Rehabilitation Referral (Project TWO of TWO)

QI projects are built as a TWO-PART component

Part 1

Setup

Here you set up and understand the project, ensuring you have everything in place to start your project

Part 2

Project

Here you have all the tools and resources to keep track of your progress towards completing the project successfully

Better setup, better success

Setup

Getting started

Getting started

Start by working through the set-up phase of this project, setting yourself a goal according to the time you have available to dedicate to this project, ensuring your team are aware of the project and you have been given the authorisation from your practice manager to complete the project.

Progress through the Set-up phase of your QI project before moving down to the Project phase.

The aim of this QI project

The aim of this Quality Improvement Project is to refer 70% or more of people patients with COPD (who are functionally disabled by breathlessness) to pulmonary rehabilitation (PR), and evidence this with the appropriate SNOMED code in their notes, by November 2021.

This is the second of two projects, which focuses on referring those patients who are functionally disabled by their breathlessness, to a formal pulmonary rehabilitation service.

This project should be completed after the first project, which focuses targeting all patients on the COPD register and letting them know that the COPDhub app, which provides them with loads of really useful advice on staying well and keeping active with COPD.

Who is this project suitable for?

This QI project is aimed at primary care teams who have a register of COPD patients.

Why is this important?

Data collected from GP practices across Wales suggest that only 56% of people with COPD have been referred for pulmonary rehabilitation. Pulmonary rehabilitation is one of the highest value interventions for patients with COPD; on completion of a PR programme, a high proportion of patients achieve important gains in exercise performance and/or health status.

This QI project will ensure that more patients are offered this high value intervention, and those who do not meet the criteria for pulmonary rehabilitation are advised to use the COPDhub app which contains a lot of valuable resources for patients with COPD.

What will I get for completing this project?

Good data entry directly improves patient care, which will also help you identify gaps or errors in the patient record or diagnosis.

On completion of this QI project, you will also get a certificate for your work. You will also be able to use this QI project as evidence towards CPD and professional revalidation.

Mark Complete

Readiness

Make sure you have the knowledge and expertise to undertake this project successfully.

If you are confident you have the skills and knowledge to manage a patient with COPD, mark this section as complete using the button below.

If you want to check your level of understanding, or need a refresher, check out the associated learning and assessments for this QI project, in line with the All Wales approach.

Mark Complete
Assessments:
Education programmes:
Mark Complete

Your capacity

Capacity is the most important aspect for the successful completion of any project  – ensure you have the capacity, time and ability to complete your project in a suitable timeframe.

Start by outlining how much time you have to commit to this project.

For example: Over the next six weeks, I will commit one 4-hour clinic (Wednesday afternoon) to completing this project.

And use the calculator provided to work out how many patients you can review in this time.

It is estimated that each patient action for this QI project will take 15 minutes, but adapt locally.

When estimating the time for each patient action on this QI project, think about how long it takes for a COPD Annual Review, and to enter the correct code into the patient’s notes.

When will my project start:

When will my project be completed by:

How much time do I have to dedicate to my project each week

Each patient action for the project will take 15 minutes

Recommended time is 15 minutes per patient.

Your current capacity


Please complete form to calculate capacity

* use the capacity calculator to edit or update your time frame

Mark Complete

Alignment

In order for your project to get underway and to be successful, your manager(s) will need to understand the importance of the project and agree your time commitment.

Name

Job title

Email

Contact 1 details not complete.

Sent email
Responded and signed off project

Name

Job title

Email

Contact 2 details not complete.

Sent email
Responded and signed off project
Mark Complete

Communication pack

It’s important that your colleagues know about the project.

You may want to include colleagues in the project, and they may need to know about other demands on your time. Let them know that you are focusing on QI with these useful resources.

Resources

Communication template – manager(s) and GP partners 4

Mark Complete

Milestone Map

Keep track of your set-up progress and make sure you are on track to getting started with your project with the timeframe you have added in your capacity calculator.

Your Progress

Getting started

Readiness

Your capacity

Alignment

Communication pack

Milestone Map

113

Start Date

Not Set

113

End Date

Not Set

Mark Complete

Project

Project overview

The aim of this QI project

The aim of this Quality Improvement Project is to refer 70% or more of people patients with COPD (who are functionally disabled by breathlessness) to pulmonary rehabilitation (PR), and evidence this with the appropriate SNOMED code in their notes, by November 2021.

This is the second of two projects, which focuses on referring those patients who are functionally disabled by their breathlessness, to a formal pulmonary rehabilitation service.

This project should be completed after the first project, which focuses targeting all patients on the COPD register and letting them know that the COPDhub app, which provides them with loads of really useful advice on staying well and keeping active with COPD.

A recap on the evidence

Data collected from GP practices across Wales suggest that only 56% of people with COPD have been referred for pulmonary rehabilitation. Pulmonary rehabilitation is one of the highest value interventions for patients with COPD; on completion of a PR programme, a high proportion of patients achieve important gains in exercise performance and/or health status.

This QI project will ensure that more patients are offered this high value intervention, and those who do not meet the criteria for pulmonary rehabilitation are advised to use the COPDhub app which contains a lot of valuable resources for patients with COPD.

What will I get for completing this project?

Good data entry directly improves patient care, which will also help you identify gaps or errors in the patient record or diagnosis.

On completion of this QI project, you will also get a certificate for your work. You will also be able to use this QI project as evidence towards CPD and professional revalidation.

Instructions

Project steps

Step 1

As part of routine COPD review, identify and code correctly the patient’s MRC score.

Step 2

Refer patients with a score between 3-5 for pulmonary rehabilitation and code accordingly.

Step 1 – During a patient review check the patient’s MRC score

During a routine COPD review, check the patient’s MRC score:

  1. Not troubled by breathless except on strenuous exercise
  2. Short of breath when hurrying on a level or when walking up a slight hill
  3. Walks slower than most people on the level, stops after a mile or so, or stops after 15 minutes walking at own pace
  4. Stops for breath after walking 100 yards, or after a few minutes on level ground
  5. Too breathless to leave the house, or breathless when dressing/undressing

Code the patient’s MRC score appropriately:

MRC 1

  • Read code: 173H.
  • SNOMED code: 391120009

MRC 2

  • Read code: 173I.
  • SNOMED code: 391123006

MRC 3

  • Read code: 173J.
  • SNOMED code: 391124000

MRC 4

  • Read code: 173K.
  • SNOMED code: 391125004

MRC 5

  • Read code: 173L.
  • SNOMED code: 391126003

Step 2 – Make a referral

Identify any patients who are functionally disabled by their breathlessness, i.e. they have a Medical Research Council Dynspnoea Score between 3 and 5.

For those patients who have a MRC score between 3 and 5, discuss referral to Pulmonary Rehabilitation and code it accordingly:

  • Read code: 8H7u.
  • SNOMED code: 24461000000105

Recording your progress

For every patient whose record you change, whether that’s recording a patient’s MRC score, or referring them to a pulmonary rehabilitation programme, be sure to record this in the ‘Progress’ section of the QI platform.

Resources

Attached below are a selection of resources to support you through your project.

Resources

Patient letter template – referral for PR

Recommended Read and SNOMED codes

NACAP Clinical Audit Report – Wales Primary Care

Supported self-management for COPD

Self management for patients with COPD (Cochrane Review)

BTS Guideline on Pulmonary Rehabilitation in Adults

Progress

Add the number of patients that you have addressed according to this project.

You should see your progress bars increase as you get closer to your goal.

Your current capacity


Please complete form to calculate capacity

* use the capacity calculator to edit or update your time frame

Capacity Calculator

Click on the chevrons for more information on your progress

Project data not set. Please complete your project's capacity settings.

Project data not set. Please complete your project's capacity settings.

Certificate

Your dynamic certificate can be found below. You can generate a certificate at any point during your QI project, and the certificate will be updated when you make further progress.

Sign Off

This QI project can be signed off by yourself.

Please sign off by clicking the button below. This will make your certificate available.

Download Certificate

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