QI

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

Getting the diagnosis right for patients on the COPD register

The COPD Diagnostic Review (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

Why is this important?

Data collected from GP practices across Wales suggest that only 11.5% patients on the COPD registers have evidence of both:

  • Post-bronchodilator spirometry with FEV1/FVC ratio less than 0.7
  • AND the correct SNOMED code

This QI project will ensure that the COPD register is coded correctly, and every patient who does not have all the evidence to support a diagnosis of COPD is invited in for a diagnostic review.

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.

Who is this project suitable for?

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

The aim of this QI project

The aim is to ensure all patients on the COPD register have an accurate diagnosis of COPD using post-bronchodilator spirometry and the correct SNOMED code.

This is the second of two projects, which involves inviting a patient in for a review of their COPD diagnosis and coding them correctly.

This project should be completed after the first project, which focuses on cleaning the register, checking every patient with COPD has the correct Read Code or SNOMED code, and removing any patients who have spirometric evidence that refutes the diagnosis of COPD. Only once this has been completed, will you know which of your patients need a review of their diagnosis.

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.

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 make an accurate diagnosis of 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 30 minutes, but adapt locally.

When estimating the time for each patient action on this QI project, think about how long it takes to perform a post-bronchodilator spirometry and 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 30 minutes

Recommended time is 30 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

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 is to ensure all patients on the COPD register have an accurate diagnosis of COPD using post-bronchodilator spirometry and the correct SNOMED code.

This is the second of two projects, which involves inviting a patient in for a review of their COPD diagnosis and coding them correctly.

This project should be completed after the first project, which focuses on cleaning the register, checking every patient with COPD has the correct Read Code or SNOMED code, and removing any patients who have spirometric evidence that refutes the diagnosis of COPD. Only once this has been completed, will you know which of your patients need a review of their diagnosis.

A recap on the evidence

Data collected from GP practices across Wales suggest that only 11.5% patients on the COPD registers have evidence of both:

  • Post-bronchodilator spirometry with FEV1/FVC ratio less than 0.7
  • AND the correct SNOMED code

This QI project will ensure that the COPD register is coded correctly, and every patient who does not have all the evidence to support a diagnosis of COPD is invited in for a diagnostic review.

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

Invite all patients without evidence of diagnostic testing on the COPD register (gathered in part one).

Step 2

Provide all patients with test (post-bronchodilator spirometry) for COPD diagnosis to confirm or disprove diagnosis.

Step 1 – Invite patients for a diagnostic review

Ensure you have completed the first QI project in this series ‘Fixing the COPD register’. From this project, you should have a list of patients who need a review of their COPD diagnosis:

  • Those who have no record of spirometry
  • Those who have a record of spirometry which is not post-bronchodilator
  • Those who have a record of poor quality spirometry

In the resources section of this project, you will find some examples of template letters to use to invite a patient in for a review of their diagnosis.

Step 2 – Perform a post-bronchodilator spirometry measurement

Ensure your patient has taken their inhaler at least 20-minutes before testing and perform spirometry.

Remember, post-bronchodilator spirometry, or spirometry performed after administration of a reliever inhaler, is the test needed to confirm a diagnosis of COPD.

Once you have achieved good quality spirometry results, record this results in the patient’s notes with the correct code for post-bronchodilator spirometry:

  • Read Code: 339m
  • Or SNOMED code: 407603001

AND record the FEV1/FVC ratio. This should be a decimal number, not a percentage.

  • For example, 0.65
  • NOT 65%
  • To convert a percentage to a ratio, divide by 100.

At this stage, you will have confirmed or refuted the patient’s diagnosis. Click through the dropdown menu below for more details.

For those patients who now have evidence of a post-bronchodilator spirometry with a FEV1/FVC ratio less than 0.7, confirm the diagnosis and continue managing their COPD.

For those patients who have evidence of a post-bronchodilator spirometry with a FEV1/FVC ratio greater than 0.7, remove them from the COPD register and consider a differential diagnosis.

Recording your progress

For every patient who you review, whether you find evidence to confirm or refute their diagnosis, 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 – invitation for COPD diagnostic review

Recommended Read and SNOMED codes

NACAP Clinical Audit Report – Wales Primary Care

Quality Assured Diagnostic Spirometry for Chronic Obstructive Pulmonary Disease

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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