NHS Choices Expert Blogs – Asthma Blog

BTS Smoking Cessation PowerPoint Slides

BTS Consortium on Sleep Apnoea CD ROM "Toolkit" now available

Oxygen Services poster presented at the BTS

The Global Initiative for Asthma (GINA)

Two new Commissioning Guides produced by NICE for Pulmonary Rehabilitation and COPD Early Discharge

Bristol COPD Knowledge Questionnaire, (BCKQ)

ARNS Discussion Forum and the Professional Development section of the website

Respiratory Palliative Care Guidelines

NSF for COPD

ARTP Papers

The ARTP have produced from a series of workshops and consultations a set of position papers with the hope of both informing and setting standards on various topics.

The finished papers are available on the public area of their website www.artp.org.uk under downloads - ARTP standards.

End of Life care in Respiratory Disease

The first BTS/ARNS ‘End of Life Care in Respiratory Disease’ course was run at the University Hospital of South Manchester. It was organised and run by Dr. Anita Simmonds (respiratory consultant at the Brompton Hospital London, Jenny Till (respiratory nurse specialist from Cumbria PCT), Michael Connolly (palliative care nurse consultant) and Annette Duck (respiratory nurse specialist) , both from the University Hospital of South Manchester. The course was limited to 25 delegates who travelled to Manchester from all over the country and was split into 3 days, 2 months apart in order to give delegates time to incorporate learning into clinical practice. Communication models of care developed within the UHSM Trust by Mike Connolly including SAGE & THYME™, and a model for dealing with ‘Conflict within the MDT’, were taught to delegates during the course. The course also involved the ‘SPIKES’ model for giving significant information. Professor Ashley Woodcock was on hand to help the team role play in the session entitled ‘Conflict within the MDT’, which he did admirably. The course uses real-life case scenarios for discussion of the clinical and personal dilemmas towards the end of life in respiratory disease. The teaching team have since been invited to run the course in Belfast for the benefit of the whole respiratory group at Belfast City Hospital.

Update on Sleep apnoea June 2008

Carol Beckwith reports

First announcement of important new sponsorship opportunities for courses at Education for Health

Recent significant developments in education funding arrangements between Education for Health and Astra Zeneca mean that significant sponsorship of between 85 and 100% is available for nurses wanting to undertake respiratory training this summer.

Places will be allocated on a first come – first served basis. Courses available are listed in the table and dates of all courses can be downloaded from the newly updated Course Calendar at www.educationforhealth.org.uk/pages/_documents/course_prog_jan08.pdf .

To reserve your place call Laura Edwards on 01926 836832 or l.edwards@educationforhealth.org.uk

Undertrained primary care nurses “uncomfortable” treating allergy

National survey exposes huge lack of allergy training in primary care nurses, despite year-on-year increase in number of allergy patients.

Three-quarters of primary care nurses have admitted to lacking even basic training in treating allergies, and more than half say they feel “uncomfortable” seeing patients with allergy-related conditions.

This is despite the fact that in the UK the incidence of common allergic diseases has trebled in the last 20 years, to become one of the highest in the world – one in three of the UK population will be affected by allergic disease at some time in their life.1

This is increasing the burden on primary care, where the majority of such patients first present and where most of those with more minor or moderate symptoms will remain for treatment.

However, in a survey of more than 1,100 primary care nurses by the journal Nursing in Practice – http://www.nursinginpractice.com <http://www.nursinginpractice.com/> - only 25% had any kind of training in allergy, and 53% felt uncomfortable working with patients with allergy-related conditions.

“Without formal training I’m lacking in confidence,” said one practice nurse from Scotland. “I don’t feel I know enough about allergy to be able to advise on anything more than on a superficial level,” commented a practice nurse from Sheffield.

“Training in ‘general’ allergy is difficult for nurses to access locally,” says John Collard, Clinical Director of Allergy UK. “The few nurses who have had training have normally done this in relation to a particular condition relating to allergy, such as asthma or eczema.”

In addition, 23% of nurses who responded to the survey described themselves as the main nurse in their practice dealing with allergy. Yet, surprisingly, only 29% of these had any form of accredited training in allergy.

According to Marilyn Eveleigh, Consultant Editor of Nursing in Practice: “It is frustrating that nurses won’t/can’t undertake training. A one-day intense session would make such a difference to nursing confidence and patient support. Training is available but prioritising, funding and capacity are often lacking in primary care.”

Dr Samantha Walker, Director of Education and Research at Education for Health, is keen to point out the benefits of improving allergy services. “There is evidence that training given to health professionals improves quality of life in patients with rhinitis.”2 She also points to the importance of treating problems like hayfever given its impact on exam performance in teenagers.3

“Allergy is a condition ideally suited to management in primary care by GPs, nurses and pharmacists,” says Marilyn Eveleigh. “Practice-based commissioning groups would be well advised to consider this as a cost-effective service for patients.”

References
1. Royal College of Physicians. Allergy: the unmet need. London: RCP; 2003.
2. Price D, et al. Clin Exp Allergy 2007; 37(1):90-9.
3. Walker S, Khan-Wasti S, Fletcher M, et al. J Allergy Clin Immunol 2007;120:381-7.

NHS Choices Expert Blogs – Asthma Blog

NHS Choices is developing a project to get people blogging about their experiences of asthma on the NHS Choices website. We are therefore seeking healthcare professionals working and treating asthma, and patients who are living with this condition, who are willing to contribute to the blog. Contributions could be on anything - from pioneering research, experiences concerning asthma triggers, life stories in the news - in fact anything.
I have attached some further information about the blog. If would like to know more about this initiative , please do not hesitate to contact Rachel Bloemstien on the following number 0207 972 5718, or at Rachelle.Bloemstein@dh.gsi.gov.uk

An Early Day Motion has been tabled in the House of Commons by Fabian Hamilton requesting the Government to recognise the need for more funding, research and specialist nurses in ILD.

By following the link below http://edmi.parliament.uk/EDMi/EDMDetails.aspx?EDMID=35440&SESSION=891
you can see the EDM.

We now need nurses, doctors and patients to lobby their MP’s to sign up to this.

By going to the link below and following simple instructions you can find out who your MP is and email him a request to sign up to the EDM.
 http://www.upmystreet.com/commons/l/

Thank-you for supporting patients with Interstitial Lung Disease

Big Breaths Challenge

The British Lung Foundation needs you to take part in the Big Breaths Challenge - an exhilarating 10,000 feet freefall parachute jump on Sunday 22nd June at Brackley Airfield (Oxford).
No experience required.
More information.

Mucolytic Opinion Sheet

The GPIAG have recently published their latest Opinion Sheet that is an up to date review of Mucolytics.
ThisOpinion sheet has been provided courtesy of the General Practice Airways Group (GPIAG).  For more tools, resources  and information about the GPIAG visit http://www.gpiag.org.

ILD Nurse Meeting

The first national Interstitial Lung Disease (ILD) specialist nurse meeting took place in October at South Manchester University Hospital. The meeting was organised by Annette Duck who is the Interstitial Lung Disease Specialist nurse at the tertiary referral centre in the North West Lung Centre, Manchester. Following a call for all ILD specialist nurses to get in contact on the Association of Respiratory Nurse Specialist (ARNS) website, only 5 other nurses responded to specialising in ILD. These included Pauline McFarlane from the New Royal Infirmary, Edinburgh, Ross Ellis from the Royal Brompton and Harefield Trust, London, Kerry Mills from County Hospital, Hereford and Geraldine Bale from the Heartlands Hospital, Birmingham. They are pictured here with Nurse Consultant - Mr. Mike Connolly – Palliative Care Specialist and Dr Lisa Spencer – SpR Respiratory Medicine/Research Fellow with Sub Speciality Training in ILD.  Julie Morgan who works in Nottingham unfortunately could not attend.
         The nurses highlighted the need for nurse specialists in ILD stating that this had traditionally been a neglected area of respiratory nursing which now needed addressing. It was acknowledged that patients needed education and support in order to learn how to live and manage these lung conditions and that nurses had a vital role to play in supporting and teaching them. It was hoped that this is the beginning of encouraging nurses to take up the challenge of caring for patients with Interstitial Lung Disease and for the future the nurses hope to put on a study day unravelling the complexity and myths surrounding the ILD’s.

A Nurses’ Guide to the Insertion and Removal of Chest Tubes and Management of Chest Drain in Adults

Kevin Clark, Clinical Nurse Consultant in Brisbane, Australia and regular visitor to the ARNS Website has kindly alerted us to a project that he has been involved in to develop a specific training and development package with audit tools for the Insertion and Management of Chest Drain in Adults. We have posted this on the Tools section of our website and you can also contact Kevin for further details or (as he has requested), to give him some feedback from a UK perspective.

Nursing Times Allergy Articles

The Nursing Times has produced a series of articles in association with ARNS that may interest you, one on Allergy and the Respiratory System that provides essential information about allergies affecting the respiratory tract and can be accessed here:

http://www.nursingtimes.net/nursingtimes/pages/allergysectionlanding and the other on smoking cessation that provides up-to-date information and resources to assist you in educating, guiding and encouraging your patients who want to stop smoking. This can be accessed here: http://www.nursingtimes.net/nursingtimes/pages/smokingcessation

Cough into Context Report

The Cough into Context report is an educational tool for healthcare professionals designed to provide guidance on the management of productive cough both in stable COPD and in exacerbations."

BTS Smoking Cessation PowerPoint Slides

The BTS Tobacco Committee have produced a set of PowerPoint slides for use in educating all healthcare professionals about why and how to discuss with patients the benefits of giving up smoking. This tool comes with speaker notes so that even those with little knowledge can use the slides effectively and there are a large and varied selection of slides so that they can be used as required for different situations.

BTS Consortium on Sleep Apnoea CD ROM "Toolkit" now available

For those of you who were able to attend the BTS Winter Meeting, you will be aware that a CD ROM was launched by the BTS Consortium Group on Sleep Apnoea. This CD ROM provides an educational "toolkit" for all those working in the field of Sleep Medicine. It has evolved after months of hard work and  input from physicians, technologists and nurses, who as representatives of the consortium, felt there was a need to standardise information for the multidisciplinary team across the UK.

The CD ROM has a series of modules that can be worked through and used to enhance the learning environment in your locality.

Carol Beckwith, who represents ARNS on the consortium, says "It is an invaluable tool for all nurses working with patients who have sleep apnoea and is presented in a very comprehensive way"

Copies of the CD ROM can be obtained from Angela Hurlstone, ARNS Secretariat.

Oxygen Services poster presented at the BTS

This poster may be of interest to those working in English or Welsh Health Organisations where all patients using oxygen have not already been reviewed to see whether their use of oxygen is appropriate. Considerable savings have been made in Blaenau Gwent where a Respiratory Nurse Specialist initially reviewed all patients that were not already known to secondary care; out of the 239 patients on oxygen that were assessed, 117 patients had their oxygen discontinued as it was found to be inappropriate. It was calculated that if these patients had remained on oxygen for another year, it would have cost the PCT £63116.55. It is clearly not economic for PCTs to ignore oxygen service provision and so some respiratory nurses may find this information useful to share with commissioners for the planning of oxygen assessment and review services within their area. "

On 13 November 2006, The Global Initiative for Asthma (GINA) announced the release of a new Global Strategy for Asthma Management and Prevention:

Main document: "Global Strategy for Asthma Management and Prevention"

Primary Care summary, 3 pages: "The major changes in the GINA report: Implications for primary care"

Two new Commissioning Guides produced by NICE for Pulmonary Rehabilitation and COPD Early Discharge

The National Institute for Clinical Excellence, (NICE) has recently published two new commissioning guides; one for the development of a pulmonary rehabilitation service for patients with COPD and one for an Assisted-discharge service for patients with COPD.  Although they are quite general, feedback so far has been very positive. They aim to:

• support general commissioning decisions on potential service reconfiguration in England
• assist financial modelling and costing by offering a tool to calculate and cost service provision in your area
• provide a framework for investment decisions
• highlight relevant national priorities
• signposts NICE guidance and other relevant clinical information.

Both guides are a useful resource for clinical leads in primary care trusts (PCTs) and practice-based commissioners (PBCs); commissioning staff in PCTs and PBCs; cluster/locality managers in PBCs; business managers; finance and information staff.
The guides should be read in conjunction with the current NICE clinical guideline for COPD that cover clinical evidence and cost effectiveness: http://www.nice.org.uk/page.aspx?o=cg012niceguideline
The commissioning guides can be accessed online at: http://www.nice.org.uk/page.aspx?o=commissioningGuides
By using the left hand navigation menu both guides can be openly accessed.
The financial modeling and costing tool is for commissioners in primary care organizations in England only. Registration and access to a secure log-in is limited to 10 people per primary care organization and can be accessed at:
http://www.nice.org.uk/page.aspx?o=commtoollogin
In summary the pulmonary rehabilitation guide:

• makes the case for commissioning a pulmonary rehabilitation service for patients with COPD
• specifies service requirements
• helps you determine local service levels
• helps you ensure corporate and quality assurance.

• makes the case for commissioning an assisted-discharge service for patients with COPD
• specifies service requirements
• helps you determine local service levels
• helps you ensure corporate and quality assurance.

Bristol COPD Knowledge Questionnaire, (BCKQ)

A new tool to assess COPD patients knowledge of their condition has been developed by Dr Roger White and colleagues in Bristol. They are happy to share it with you and have given permission for you to download it from the ARNS site. Find out more here.

ARNS Discussion Forum and the Professional Development section of the website

Do you have useful information to pass to other respiratory nurses?
Please share things such as useful websites for yourselves or patients; New ways of working/ service developments; etc on the Discussion Forum.

If you have useful Protocols, Care Pathways, Assessment Tools, Self Management Plans, or other Guidelines that you would be willing to share, these can be put on the Professional Development part of the website, please contact Jenny Till.

Respiratory Palliative Care Guidelines

Are you trying to develop respiratory palliative care in your area? You may be interested to know that a multi disciplinary working group of respiratory and palliative care health professionals from the Mersey and Cheshire area have recently published local guidelines for their area that they are happy to share with others.

Click here for further information.

NSF for COPD

Photo taken at the official launch of the British Thoracic Society, BTS 2006 edition of “The Burden of Lung Disease” at the House of Commons on 28th June this year. Concerned nurses take the opportunity to discuss some of the challenges currently facing Respiratory Nurse Specialists with Rosie Winterton, MP, after she announced that there will be an NSF for COPD.

Left-Right: Liz Walker, (ARNS); Sam Prigmore, (ARNS); Rosie Winterton, MP; Jane Scullion, (RCN Respiratory forum); Monica Fletcher, (Chief Executive Education for Health).

The announcement by the DOH that there will be a National Service Framework, (NSF) for COPD in England was welcomed by ARNS. This has come about after years of work to raise awareness of the true burden of respiratory disease and direct lobbying of the government by members of the Respiratory Alliance* and other healthcare professionals from organizations such as ARNS and the RCN Respiratory Forum. The British Lung Foundation, BLF has recently published a new COPD patient survey that showed COPD is still not being diagnosed, treated or managed well despite the millions of people who have the disease and the huge burden placed on the NHS. Responding to the announcement of the NSF for COPD, Helena Shovelton, Chief Executive of the BLF said: "This is welcome recognition by the Government of the many millions of people with lung disease. COPD has to be a priority for the NHS if we are to address the shocking statistics of the disease and improve standards of diagnosis and care. We hope that this is the first chapter of a new NSF to be followed by others in asthma, obstructive sleep apnoea and interstitial lung disease."

ARNS also welcomes the Healthcare Commission's report, 'Clearing the Air' http://www.healthcarecommission.org.uk/_db/_documents/COPD_report.pdf. This states that “The Department of Health should develop a national service framework (NSF) for COPD. This would encourage greater focus on this previously neglected condition. It would also provide an opportunity to embed in healthcare services more meaningful indicators for measuring the outcome of care and treatment for people with COPD….. A complete set of indicators will be developed in consultation with key stakeholders and monitored over time”

We plan to join with other key stakeholders to do all we can to ensure that the process of drawing together a respiratory NSF firstly for COPD is a successful and positive process and to work towards lobbying for the creation of further “chapters” for other respiratory disease areas such as asthma, respiratory allergies, occupational lung disease, obstructive sleep apnoea and interstitial lung disease.

*Respiratory Education UK, Education for Health, National Asthma Campaign, (NAC) General Practice Airways Group, (GPIAG) British Thoracic Society, (BTS) British Society for Allergy and Clinical Immunology, (BSACI) British Paediatric Respiratory Society, (BPRS) British Lung Foundation, (BLF)