In Northwest London, Imperial College Healthcare NHS Trust is undertaking the important work of improving patient and carer interaction in CLAHRC NWL’s Non-Invasive Ventilation (NIV) project. Many care plans and physical and mental maladies present complex care circumstances, whether it be in terms of treatment, maintenance of care, or a multi-symptom scenario. We have chosen to focus on the NIV project because of the pervasive complexity and fatality of COPD related illnesses.

In the United Kingdom, 3 million people have COPD and it is the 5th leading cause of death. Type 2 respiratory failure in late disease causes significant morbidity and mortality. Non-invasive ventilation (NIV) is the best treatment we can offer these patients, reducing mortality by fifty percent. Unfortunately, NIV is stressful and frightening. This Improvement Project’s goal is to improve this experience and the outcome for patients with severe COPD.

To achieve this goal the team is working to improve staff awareness of the patient perspective through a holistic approach to NIV education. A primary driver of the project is the development and implementation of a NIV bundle to ensure excellent NIV delivery and improve outcomes. Documented changes use Experience Based Co Design (EBCD) highlighting collaboration between patients and carers, as well as professionals, to enhance service delivery.

Changes to the service are clearly identified through the priorities identified in the EBCD and phased according to resource allocation, for example the development of a video for patient and carer education will take longer to develop and roll out compared to ensuring that clinical staff engage patients in a compassionate communication style. Bundles are well recognised to improve care (Resar 2012), and this has been shown in NIV (Clark 2012). Good patient experience is known to correlate with high quality care (Manary 2013) and therefore by basing both the bundle and training programmes around patient experience we hope to ensure high quality safe and effective care. and the published literature around NIV tells us that treatment is often unpleasant for patients and that simple interventions such as taking the time to explain the treatment to patients and relatives can improve experience and outcomes (Smith 2015).

By focusing the treatment experience on the patient/carer relationship and the emotional well-being of the patient, as well as a positive result, some suffering with COPD may be more likely to agree to treatment. Professional development of carers regarding patient interaction is always to be encouraged but could have a life-changing outcome in managing this particular complex need in Northwest London hospitals.

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