Overview

NIVThis project aims to improve the quality, safety and delivery of Non-Invasive Ventilation (NIV) in acute hospital trusts across Kent, Surrey and Sussex (KSS), through enabling clinical staff to confidently and consistently deliver safe acute NIV.

Using a collaborative approach, working with local clinicians and e-learning for Health (el-fh), we developed 6 modules for an e-learning program which is free to access across the region. The modules were launched in July 2016; with 809 unique users from 358 organisations.

Modules:

1: Introduction to Ventilation

2: Selection of Patients for NIV: Indications and Considerations

3: Set Up

4: Monitoring

5: Acute Non-invasive Ventilation Ongoing Management and Escalation

6: Difficult Decisions

Modules can be accessed here: http://www.e-lfh.org.uk/programmes/acute-niv/

To support delivery of the project we created a regional KSS NIV Network – this brought together lead practitioners from all acute hospital trusts in the region to form a collaborative, allowing teams to share good practice leading to improved leadership and enhanced clinical skills.

Improved delivery of NIV will ensure improved safety of patients and ultimately reduce mortality. The project includes evaluation for 12 months after implementation of learning outcomes and an audit of Acute NIV outcomes.

Challenge/ problem identified

The number of patients treated with NIV is relatively low (KSS region: 916 patients in 2011-12 and 899 patients in 2012-13, data source: Quality Observatory), however sub-optimal delivery and patient selection has serious consequences (BTS National NIV Audit reported 26% in-hospital mortality associated with NIV). 

In February 2015 a Patient Safety Alert was issued relating to 3 NIV associated deaths; attributed to improper use of equipment. However, there are additional concerns relating to inappropriate use of NIV; increased severity of presentation, complexity of patients (source: BTS National Audit) and a lack of clinical knowledge or confidence leading to health care practitioners (HCPs) to start NIV instead of appropriate end of life care.

In the KSS region, NIV care is impeded by several factors:

  • No standard acute NIV training
  • No regional NIV network
  • No standard competency agreement
  • Hospital sites use different equipment (practical skills not transferable)
  • No leadership framework

Actions taken

The project objectives set to achieve delivery of the aim are;

  • Acute NIV competency standards agreed by and for KSS
  • Each trust in KSS has a named consultant NIV clinical lead
  • Each trust/hospital site in KSS has a named NIV Champion
  • Theoretical training package and resources (standardised for the region) available online
  • Practical training sessions established and regularly run in localities, supported by the regional network
  • Regular reports received from the Acute NIV champions of each trust/hospital site on the number of HCPs successfully completed the NIV competency trainings
  • 2 regional NIV network meetings held per year
  • Improved patient experience and involvement of acute NIV patients in the regional network
  • Reduction of inappropriate acute NIV care (improved access to end of life care and advanced care planning)

Impacts/ outcomes

There is measurement of two aspects of the project;Acute NIV competencies project

1) evaluating the learning

2) measuring the impact of the education on the delivery of NIV

The evaluation of the project consists of questionnaires attached to the e-learning package and practical session. There is also a data collection tool with parameters aimed at looking at the quality of delivery of acute NIV in addition to the outcomes.

E-Learning user’s self-reported;

  • confidence in administrating NIV appropriately increased by 46%
  • ability to administer NIV in a consistent manner increased 59%
  • and understanding of when not to administer NIV increased 65% between pre and post training questionnaires.

To help demonstrate the difference the e-Learning for Healthcare training has made to the delivery of care across Kent, Surrey and Sussex, we have built a web-based data collection tool called IMPACT (Information Management, Processing and Collection Tool). This tool measures whether patients received best practice during their in-patient stay and details as to their outcome.

This tool is designed to quickly and simply capture data, resulting in minimal data burden for clinical staff and providing the AHSN with powerful insights into the changes in care offered to patients, this data will be circulated in the form of 2 dashboards a year.

Plans for the future

  • The e-learning modules are live and have no expiration date; they will be a free resource.NIV 2
  • Data extracted from IMPACT will be circulated every 6 months and this will be reviewed over time.
  • Through collaboration, a desire to improve patient safety and an identified need for change we are confident that providers will use the data to continually drive improvements in patient care.
  • The AHSN will circulate module reminders and resources throughout the year to raise awareness, spread reach and increase usage.

Which national clinical or policy priorities does this example address?

  • Care and Quality
  • Funding and efficiency

Start and end dates

The project started in September 2015; from June 2016 we anticipate work on the project will conclude other than informatics input.

Contact for help and advice

Project contact for more information:
Ellie Wells, Events & Programme Co-ordinator
Kent Surrey Sussex Academic Health Science Network
E: ellie.wells@nhs.net
T:  01293 600 300 ext 1752

Media contact for further information:
Rick Fell, Communications Lead
Kent Surrey Sussex Academic Health Science Network
E:rickfell@nhs.net
T: 07827 369797