ACE Venturi - COPD controlled Oxygen Organisation Name: Western Health Presenter: Sarah Cornish HRT 1520 Innovations Workshops and Awards 19-20 November 2015, Sydney
Summary Uncontrolled oxygen therapy is associated with adverse outcomes in patients with exacerbations of COPD Aim was to increase the proportion of patients attending ED for exacerbations of COPD who receive controlled oxygen therapy (Venturi mask or nasal prongs) Base line (2011): only 30% of patients received controlled oxygen therapy Intensive 10-month plan-do-study-act project; driven by ED nurses and involved multidisciplinary education, promotional materials Proportion of patients with COPD receiving controlled oxygen therapy increasing from 30% to 76%. Follow-up data collected in 2014, showed that 68% of patients received controlled oxygen therapy Those receiving controlled oxygen therapy were more likely to have oxygen saturation within the COPD-X guideline recommended target range of 88-92% at 30 minutes (32% vs. 16%, odds ratio 2.48, 95% CI 1.42-4.32). There was also a trend towards lower mortality (2.7% vs. 5.8%, NS) Possible to deliver evidence based practice and sustain the change! Presenter name: Sarah Cornish Contact email: sarah.cornish@wh.org.au Health Service: Western Health 2
Key Problem Uncontrolled oxygen therapy is associated with adverse outcomes in patients with exacerbations of COPD including: increased mortality and increased requirement for ventilatory support Opportunity arose as a project funded by the Emergency Care Clinical Network, Department of Health, Victoria 3
Aim of this innovation Increase the proportion of patients attending ED for exacerbations of COPD who receive controlled oxygen therapy (as opposed to uncontrolled oxygen therapy) Controlled refers to oxygen administered via nasal prongs or Venturi mask Uncontrolled refers to oxygen administered via a non-rebreather or Hudson mask 4
5 Baseline Data / Current Situation Our base line (2011): only 30% of patients received controlled oxygen therapy
6 Key Changes Implemented Initial project: Intensive project (2011) to change culture and practice regarding use of controlled oxygen therapy. Part of Emergency Care Clinical Network program (DHHS). Grant $4000. Ongoing reinforcement via inclusion in orientation program for nurses and regular refresher education sessions. No additional resources. This project was lead by the ED nursing team and included education sessions, shift champions, posters and ACE Venturi campaign theme.
Key changes implemented Follow up research project: Follow up data obtained by Professor Anne-Maree Kelly and her research team at the Joseph Epstein Centre for Emergency Medicine Research Retrospective cohort study that used a convenience sample of 378 patients across Jan 2012 March 2013- first 18 months after the project ended
9 Outcomes so far The intensive project resulted in the proportion of patients with COPD receiving controlled oxygen therapy increasing from 30% to 76% (p<0.001) Follow-up data collected in 2014, showed that 68% of patients still received controlled oxygen therapy
Outcomes so far The intensive project has had a positive clinical impact, as those receiving controlled oxygen therapy were: more likely to have oxygen saturation within the COPD-X guideline recommended target range of 88-92% at 30 minutes (32% vs. 16%, odds ratio 2.48, 95% CI 1.42-4.32) There was also a trend towards lower mortality (2.7% vs. 5.8%, NS)
11 Lessons Learnt Administration of controlled oxygen therapy has been successfully embedded in ED nursing practice for patients with COPD resulting in better adherence to guidelines and a trend towards reduced adverse events. Shift champions are powerful agents for maintaining motivation. Sustaining the change of a project can occur, but must embed principles into everyday work practices Initial and ongoing education crucial
Contact for this Innovation For more information Contact: Sarah Cornish Tel: 0418 143 407 Email: sarah.cornish@wh.org.au 12