| Staffing |
-
▸ Staff shortages -
▸ High staff turnover -
▸ Training of staff on bundle implementation -
▸ Training of staff on inhaler technique and smoking cessation -
▸ Staff not following the whole patient journey -
▸ Capability to make COPD referral-A&E nurse/doctor not referring to appropriate ward -
▸ Lack of staff engagement -
▸ Low buy in from pharmacists -
▸ Staff too busy
|
| Infrastructure |
-
▸ Added workload of bundle -
▸ Bed shortages -
▸ Ward moves -
▸ Lack of pulmonary rehabilitation service -
▸ Issues with government plans -
▸ GP involvement -
▸ Sustainability and costs of BLF booklet -
▸ Lack of communication and collaboration across sites
|
| Process |
-
▸ Lack of prompt data capture -
▸ Patient coding issues (correct disease diagnostic coding) -
▸ Lack of prompt feedback to staff on the progress of the project -
▸ Poor quality of spirometry -
▸ Completion status unclear because of community bundle end point
|
| Methodology |
-
▸ Issues using PDSA cycles -
▸ NHS sustainability tool—too generic not context specific -
▸ Unfamiliarity with tools
|
| Patient and public involvement |
-
▸ Patient involvement declined over time -
▸ Patients focused on own interest and not the projects’ -
▸ Patient illness -
▸ Patient engagement poor
|