Project Initiation Document High Impact Changes: Asthma Project Implementation

Transcription

1 Project Initiation Document High Impact Changes: Asthma Project Implementation Template PPM006 Version 1

2 Project Initiation Document Implementing High Impact Changes for Paediatric Asthma Outcomes in the East of England Planning: Project Initiation Document (PID) This PID builds on the Project Brief to fully define the project and form the contract between the Project Board and Project Manager. It provides a baseline against which the Board can assess progress, issues and ask on-going viability questions. The PID also provides a useful single source of reference for others to quickly and easily find out what the project is about. It answers the following questions: What is the project aiming to achieve? Why it is important to achieve it? Who will be involved and what are their responsibilities? How and when will it happen? Issue Date: To be added Document Number: xx Prepared by: Richard Iles and Louise Raybould Status: DRAFT Next Review Date: To be added Page 2 of 16

3 Amendment History: Version Date Amendment History 0.1 Oct-13 First draft from SCN - for comment by R Iles Reviewers This document must be reviewed by the following: Name Signature Title / Responsibility Date Version Ruth Ashmore Richard Iles Melanie Clements Jayne Haley SCN Associate Director Consultant Paediatrician (CUHFT) and Project Lead SCN Clinical Director for MNCYP SCN Manager for MNCYP Approvals This document must be approved by the following: Name Signature Title / Responsibility Date Version Ruth Ashmore Richard Iles SCN Associate Director Consultant Paediatrician (CUHFT) and Project Lead Related Documents This document should be read and approved in conjunction with the following: Name Owner Location Status: DRAFT Next Review Date: To be added Page 3 of 16

4 Contents 1 Background Definition Objectives Scope and Exclusions Dependencies Constraints Interfaces Approach Overview Assumptions Plan Stakeholder Engagement & Communications Business Case Cost Equality Organisation and Capability Governance Resource Management Controls Reporting Change Control Risks and Issues Quality Management Status: DRAFT Next Review Date: To be added Page 4 of 16

5 1 Background Asthma is the most common and challenging long term conditions of in the in childhood there were 80,000 emergency hospital admissions for asthma in the UK and of these, 30,000 were children under 14.The UK has the worst paediatric asthma outcomes compared with the rest of Europe and the highest prevalence of asthma in the world, affecting 5.4 million people of which 1.1 million are children. Levels of morbidity in children and young people are significant, with large numbers reporting symptoms during daily and school activity and disturbed sleep at night. Its is felt that 75% of hospital admissions for asthma and as many as 90% of the deaths from asthma are preventable. Despite the availability of evidence-based guidelines for the management of pediatric asthma, there remains a significant gap between accepted best practices for asthma care and actual care delivered to asthma patients. Evidence based guidance (Sign / British Thoracic Society (BTS)) has been available to primary and secondary care for over 15 years. Data would suggest that only 15% of children have active asthma plans, and few families are taught the basics of medication administration. There is also growing evidence that we often fail to implement optimal care with many children and young people not achieving the goal of asthma management, which is to lead lives free of symptoms, despite the availability of well-constructed guidelines and good medicines. This is outlined in section 4. Conversely a number of children, estimated to be as high as 600 for EoE, (based on asthma UK disease prevalence), with severe asthma are not recognised, and potentially undertreated. This group of with recognised and under reported disease severity are over represented in the paediatric asthma mortality figures. The East of England Strategic Clinical Network for Maternity, Newborn, Children and Young People has identified paediatric asthma as an area for High Impact Change. Paediatric Asthma is a high volume condition where targeted and effective interventions could have a high benefit to patient s health, with a beneficial effect on the health care economy. In early 2013 the (then) Strategic Network for Child Health and Wellbeing in the East of England commissioned Sustain to develop a portfolio of asthma management plans which could be adopted by primary and secondary care for all paediatric asthma patients. At the time of writing these documents have been developed and are being trialled in 4 pilot sites in Cambridge and Suffolk with a view to developing a set of recommendations for their amendment and adoption across the region. The recommendation report is due to be published in December This PID has been developed as a proposal to build on the work done in the development and trialling phase and to roll out the implementation of the asthma management toolkit from In keeping with the RCPCH s statement on reconfiguration of services the implementation will focus on the following: Multidisciplinary teams delivering child healthcare outside the hospital Supportive paediatric provision to primary care Status: DRAFT Next Review Date: To be added Page 5 of 16

6 Support care across children s healthcare pathways Ensuring shared standards are supported by training programmes for professionals in all settings A robust, discreet and independent service review programme Meaningful involvement of patients, families and the wider public 2 Definition 2.1 Objectives The objective of the second phase of the High Impact Changes in Asthma project is to improve outcomes for children and young people in the East of England by: 1) Piloting the effectiveness of an integrated asthma management toolkit focussing on improved management of paediatric asthma 2) Ensuring the quality of asthma care is improved through supporting healthcare professionals to: Establish the correct diagnosis Select the most appropriate treatment Instruct disease management techniques Develop a partnership between care provider and patient to promote adherence to treatment plans 3) Ensuring that clinical interventions for paediatric asthma are appropriate and effective 4) Developing and implementing a set of educational materials and a training programme for professionals involved in paediatric asthma management across all care settings 5) Establishing an accreditation/kitemark system for primary care organisations who have trained 2 professionals to the agreed standard and implemented the asthma management toolkit 6) Testing the feasibility of the recommendations made in the first phase of the project and developing amendments where necessary 7) Evaluating the effectiveness of the interventions in terms of their impact on several KPIs which will include: The number/proportion of paediatric patients with an agreed asthma management plan The number of emergency admissions for children and young people with asthma within the region The rate of compliance for patients with prescribed therapy The number and distribution of referrals from primary to secondary care by BTS level of asthma severity score. An internal audit of prescribed medication in secondary care Qualitative feedback from patients, families and professionals 8) Monitoring the variation in outcomes for paediatric asthma patients within the East of England The above objectives align with the NHS Outcomes Framework and the NHS Business Plan 2013/ /16, in particular priorities : Status: DRAFT Next Review Date: To be added Page 6 of 16

7 1) Satisfied patients; 3) Outcomes Framework Domain 1: Preventing people from dying prematurely; 4) Outcomes Framework Domain 2: Enhancing quality of life for people with long term conditions; 6) Outcomes Framework Domain 4: Ensuring people have a positive experience of care; and 8) Promoting equality and reducing inequalities in health outcomes. 2.2 Scope and Exclusions This project will comprise piloting and implementing the asthma management toolkit and developing an education programme which will impact on the following East of England sectors: 1) Tertiary, Secondary care; A&E, respiratory clinics, general paediatric services 2) Primary care and general practice 3) Pharmacies 4) Community nursing 5) CCG commissioners and CYP Leads This project and its evaluation will only focus on children and young people with asthma in the East of England region age 0-16, it will not cover those age 17 and over. 2.3 Dependencies This project/programme is dependent on the agreement of adequate resourcing as per section 4.1. It will also be dependent on the successful engagement of CCGs and clinical teams in agreeing to assess themselves against current standards adopt the recommended toolkit and release their staff for training in line with the project education programme. 2.4 Constraints The evaluation of the project will be dependent on the availability of a variety of KPIs, some of which may not be published during the identified evaluation period. 2.5 Interfaces This project is aligned with the delivery of the first phase of the project currently underway, as detailed in section 1. Status: DRAFT Next Review Date: To be added Page 7 of 16

8 3 Approach The approach for rolling out the second phase of the High Impact Changes in Asthma project will be as follows: 1) To identify an educationalist to work with the project group to design and develop a set of learning materials for asthma specialist nurses and practice nurses this is likely to include a mixture of online/self-taught and face to face teaching elements and will provide the learner with an accreditation in paediatric asthma management. 2) To identify a minimum of six early implementer sites (one within each locality Bedfordshire, Cambridgeshire, Norfolk, Suffolk, Hertfordshire and Essex) to pilot and operationally test the revised toolkit and education programme; the sites will be determined from the SCN Children and Young People s Steering Group priorities as well as the sites level of preparedness. 3) To carry out the key detailed planning necessary with each site to ensure the successful set up and delivery of the pilot 4) Each pilot site will require the establishment of a Steering Group with membership from a variety of stakeholders including the local CCG, GP practice and pharmacist/s. An identified project manager will support each pilot site throughout the period. 5) A minimum of 2 members of staff from the pilot site (likely to be the asthma specialist nurse, practice nurse or pharmacist) will undertake the developed training course. This accredited course is likely to include some online training/core reading, some face to face learning with an accredited trainer and an exam. Following the formal training the nurse/pharmacist will be asked to identify 3 other professionals to whom they can pass on the training evidence of spread of learning will be required before formal accreditation is awarded. 6) Those practices who are able to demonstrate that they have 2 members of staff who have completed the training and received accreditation, and who have also have adopted the asthma management toolkit, will be recognised as a practice specialising in the management of paediatric asthma and awarded a kitemark which can be publicised to patients and their families. 7) The project manager will work with the pilot sites to produce a report outlining learning from the pilot, this will include details of delivery models and associated costs. 8) In addition an overall SCN-wide report will be produced detailing specific plans for regional rollout over the following 18 months. This will be shared with all CCGs and commissioners as a recommendation of best practice. 9) An updated version of the toolkit and educational materials will be published, updated with the learning from the early implementer pilot sites. 10) Evaluation will commence following completion of the pilot implementation. This will include feedback from service users and professionals. 11) It is anticipated that the evaluation will demonstrate cost neutrality or cost savings for commissioners as improved quality of care for patients will prevent escalation of issues and referrals to secondary care will be more appropriate those patients with a lower BTS score (1-3) will be managed by primary care Status: DRAFT Next Review Date: To be added Page 8 of 16

9 and those with a higher BTS score (4-5) are smaller in number but more complex, and will be managed by secondary care. 3.1 Overview Please see sections 1 and Assumptions This proposal assumes that they project team are able to facilitate collaborative working from all provider and commissioner organisations identified as part of the pilot. The pilot sites will be required to release staff for training and may be required to audit their current practice against BTS standards. 3.3 Plan Stage Overview of key objectives Project setup Identify an educationalist, work with the academic institution to develop learning materials and package Identify pilot sites, key stakeholders and project team. Agree roles and responsibilities. Produce detailed implementation plans for each of the pilot sites. Identify baseline data requirements and design evaluation model Project initiation Plan and hold launch meetings with each of the pilot sites Ensure an agreed governance structure is in place, with timescales and implementation plans agreed with each of the pilot sites Project delivery Deliver the pilots as per the agreed implementation plans it is anticipated these will take 4-6 months Ensure data is being collected as per the evaluation plan. Carry out an audit of service users and professionals Project completion Produce final report to include lessons learned, proposed revision of the toolkit/educational materials and a proposal for EoE rollout Produce final version of the toolkit, guidance and educational materials Organise and deliver a learn and share event Project Monitor ongoing and longer term outcomes TBC Proposed timescale January-May 2014 May-June 2014 July-December 2014 January-March 2015 Status: DRAFT Next Review Date: To be added Page 9 of 16

10 monitoring measures as per the evaluation plan This section should be read in conjunction with Related Documents (see page 3) Deliverables / Desired Outcomes Product / Deliverable Owner Definition Implementation plan for each of the pilot sites Evaluation plan Communications plan Risk register Launch meetings Regular progress reports throughout the project Final report Revised final version of the toolkit and educational materials Learn and share event Write up of evaluation Project team TBC 3.4 Stakeholder Engagement & Communications The key stakeholders identified as part of this project may include the following. Please note this will be further developed as part of the project communication plan. NHS Commissioners NHS Providers Non Clinical NHS England Area Teams Representatives of Clinical Commissioning Groups Commissioners and GP Leads Directors of Nursing, Quality and Safety Representatives of LETB s Acute/Community Paediatricians General Practitioners Practice Nurses Specialist Asthma Nurses Pharmacists and pharmacy managers Primary and Secondary Care Managers Health and Wellbeing Boards Strategic Clinical Network HR & Workforce Development Finance Performance Informatics Status: DRAFT Next Review Date: To be added Page 10 of 16

11 Non Clinical - Other Parents/guardians Children and young people Academic institutions This section should be read in conjunction with Related Documents (see page 3). 4 Business Case The case for change with regard to paediatric asthma management is clearly made in the following publications: Lancet 2013: Health services for children in Western Europe: Mortality from asthma, a chronic disease common in childhood, varies substantially between countries even after adjustment for the incidence of wheeze as a proxy indicator for prevalence of asthma. The UK has the worst outcomes compared with the rest of Europe. However, mortality is not the only consideration; research in several countries has shown that as many as two-thirds of hospital admissions for asthma in children could be avoided with better preventive care, including asthma action plans, improved asthma education, and reduction of risk factors (eg, parental smoking) NHS Atlas of Variation in Healthcare for Children and Young People: For PCTs in England, the emergency admission rate for children with asthma per 100,000 population aged 0 17 years ranged from 25.9 to (25-fold variation), (Suffolk shows one of the highest rates of admission and Cambridgeshire one of the lowest). Nationally when the five PCTs with the highest emergency admission rates and the five PCTs with the lowest emergency admission rates are excluded, the range is per 100,000 population aged 0 17 years, and the variation is 4.8-fold. The magnitude of variation may reflect improvements in care in the best-performing PCTs, rather than deterioration in the worst. However, it does highlight an increasing inequity in the management of asthma services, which requires urgent redress. Variation in the rate of emergency admissions may be due to a variety of reasons: suboptimal symptom management and secondary prevention in the community; suboptimal emergency care in the accident and emergency (A&E) department; differences in admission criteria among paediatric clinicians. Risk factors for childhood asthma deaths from the UK Eastern Region Confidential Enquiry : In this case series of paediatric asthma deaths, a number of important risk factors have been identified. Psychosocial and behavioural factors can lead to poor-compliance with medication. The use of noncombination LABA inhalers contributes to confusion with treatment and underuse of ICS particularly without a written management plan. Seasonal and allergic triggers remain unrecognised particularly in patients with less severe asthma as there is no routine allergy testing for asthma patients in the UK. The risks associated with disease severity and non-adherence with ICS are well recognised; however, these could be anticipated with the routine use of spirometry and a system for identifying those patients who use excessive SABAs Status: DRAFT Next Review Date: To be added Page 11 of 16

12 or who fail to attend appointments. Many of the above risk factors are likely to be preventable if asthma is phenotyped, triggers identified early, and patients educated to self-manage their condition. Training Deficiencies and Lack of Confidence Around Knowledge in Primary Care Nurses Treating Asthma and COPD Patients: Highlights the lack of confidence of practice nurses in EoE when treating children with asthma, (31% of PNs with a respiratory diploma and only 5% of those without felt confident with treating the 5-12 age group with asthma). Local audit evidence: Paediatric asthma is a condition managed predominantly in Primary Care. Locally there is clinic audit evidence to suggest a higher than expected referral to secondary care clinics of lower severity asthma (BTS step 1-2) for diagnosis, particularly in the less than 3 year age group, and less referral of higher B (BTS step 3-4). Overall there may be as many as 300+ children with severe end disease who have not been referred for specialist paediatric opinion. British Thoracic Society (BTS) and the Scottish Intercollegiate Guidelines; This guideline provides recommendations based on current evidence for best practice in the management of asthma. It makes recommendations on management of adults, including pregnant women, adolescents, and children with asthma. In sections 4 and 5 on pharmacological management and inhaler devices respectively, each recommendation has been graded and the supporting evidence assessed for adults and adolescents over 12 years old, children 5-12 years, and children under 5 years. In section 7.1 recommendations are made on managing asthma in adolescents The guideline considers asthma management in all patients with a diagnosis of asthma irrespective of age or gender NICE published QS25 asthma: This quality standard defines clinical best practice within this topic area. It provides specific, concise quality statements, measures and audience descriptors to provide the public, health and social care professionals, commissioners and service providers with definitions of high-quality care. This quality standard covers the diagnosis and treatment of asthma in adults, young people and children aged 12 months and older. Designing and commissioning services for children and young people with asthma; A good practice guide: Asthma is one of the most challenging long term conditions for patients and the NHS with the UK having the highest prevalence of asthma in the world. Many children and young people with asthma are still having their daily activities limited and their sleep disturbed. Asthma admissions in children and young people show a 19-fold variation around the country.to help improve asthma care, PCC has produced a good practice guide on asthma in children and young people, which will guide commissioners, service developers and providers on best practice asthma care. NICE published the Asthma Quality Standard in February 2013, and this good practice guide builds on that evidence-based guidance. The publication has had input from the major professional bodies and patient groups, as well as health service managers. It sets out the 20 points that good asthma services need to include, and highlights what commissioners can do to drive improved asthma care at each part of the care pathway, with examples of good practice at each step. Status: DRAFT Next Review Date: To be added Page 12 of 16

13 The economic savings: If 75% of hospital admissions for asthma are preventable, based on 2011 figures, the total asthma admission costs for Suffolk would fall from 212,656 to 53164, and for Cambridgeshire and Peterborough from 248,858 to 62,215. However there would be an increase in the referrals of the more severe asthma patients to specialist MDT teams / clinics. Furthermore there would be the maintenance of the training program and the accreditation system. 4.1 Cost The estimated cost of delivering the implementation phase of this project will be as follows: Project management: 0.4 WTE Band 7 Project Manager for 15 months 24, WTE Band 5 Project Support for 15 months from within SCN team Non pay costs, including expenses and training - 5,000 Cost of co-ordinating project steering groups, venue hire etc - 5,000 TOTAL (over 15 months) - 34, Equality One of the objectives of this project is to reduce health inequalities for children, young people and families across the East of England. This is in line with the NHS Outcomes Framework and Business Plan and reduction in inequalities will be evidenced as part of the project evaluation. 5 Organisation and Capability 5.1 Governance This project will be managed by the Strategic Clinical Network for Maternity, Newborn, Children and Young People. A nominated clinical project lead will also be identified. Status: DRAFT Next Review Date: To be added Page 13 of 16

14 Strategic Clinical Network for MNCYP CYP Steering Group High Impact Changes Project Group Pilot site 1 Steering Group Pilot site 2 Steering Group Pilot site 3 Steering Group Pilot site 4 Steering Group 5.2 Resource A high-level resource plan has been developed based on the project approach outlined above. Resource Time Role Project Leads Richard Iles and Melanie Clements 0.1 WTE Project Manager TBC 0.4 WTE Half a day a week (Jan-14 Mar-15) 2 days a week (Jan-14 Mar-15) The Project Leads provide overall coordination for the project. They are accountable for the delivery of the project in line with this document and the individual implementation plans. The Project Manager has the overall responsibility for the successful planning and execution of the project. He/she will manage the overall schedule to ensure work is assigned and completed on time, within budget and that all deliverables adhere to acceptable quality levels. He/she must identify, track, manage and resolve project issues risks and lessons learned and ensure that mitigating actions are implemented. Status: DRAFT Next Review Date: To be added Page 14 of 16

15 Project Support TBC 0.2 WTE 1 day a week (Jan-14 Mar-15) The Project Support Manager will provide general administrative and project support to the Project Manager as required including co-ordination of meetings, development of paperwork and basic data collation/analysis. 6 Management Controls This project will be managed in accordance with PRINCE2 Project Management Methodology. 6.1 Reporting Report Frequency Audience Highlight / Status Report Monthly Project Lead and high Impact Changes Project Group Progress Report Quarterly CYP Steering Group Exception Report As needed As requested Risk / Issues Monthly Project Leads Lessons Learnt Project close CYP Steering Group NHS England 6.2 Change Control Changes to the content of this PID following approval can only be authorised by the Project Lead. 6.3 Risks and Issues This section should be read in conjunction with Related Documents (see page 3). Risks and issues will be tracked and managed in accordance with the NHS England risk and issue management strategy. 6.4 Quality Management Quality management will be undertaken in line with SCN policy where applicable. Status: DRAFT Next Review Date: To be added Page 15 of 16

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