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259 Improving inpatient cystic fibrosis related diabetes (CFRD) care: The patients’ perspective
S124
11. Nursing/Psychosocial/Quality Improvement
Posters
256 Understanding the psychological difficulties patients with cystic fibrosis share at annual review
259 Improving inpatient cystic fibrosis related diabetes (CFRD) care: The patients’ perspective
K. James1 , S. Phillips1 . 1 University Hospitals Bristol NHS Foundation Trust, Bristol Royal Hospital for Children, Psychological Health Services, Bristol, United Kingdom
S. Pandya1 , P. Dyce2 , M.J. Walshaw2 . 1 Liverpool Heart and Chest Hospital, Nutrition and Dietetics, Liverpool, United Kingdom; 2 Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
Objectives: Psychological assessment at annual review has been recommended as part of psychologists roles within CF teams in the UK. Due to service constraints, the clinical psychology service within Bristol Adult Cystic Fibrosis Centre (BACFC) currently adopts a questionnaire-based approach for annual psychological assessments. An audit of these questionnaires aimed to identify the proportion of patients completing the annual psychological assessment and to understand the psychological difficulties patients within BACFC reported experiencing. Methods: An audit of patients’ responses (n = 91) to the annual psychological assessment questionnaire from January 2014 to December 2014 was completed. Results: 42% of patients within the service completed the questionnaire. The most frequently reported difficulty was stress (43%, n = 39), followed by anxiety or worry (33%, n = 30), and low mood (26%, n = 24). 23% (n = 21) of patients indicated that managing all of their treatments was causing significant problems. Patients described a range of goals related to health and wellbeing for the next year ahead. Conclusion: This audit suggests that a significant proportion of CF patients at BACFC report experiencing stress, worry and low mood, and difficulties managing all of their treatments. Furthermore, given the completion rate, the annual psychological assessment process may need to be reviewed in order to be accessible to a wider group of patients.
Objectives: In CFRD, tight glycaemic control is important, particularly when patients are undergoing IV antibiotic therapy. To facilitate this, we have developed a dedicated weekly ward round led by a CFRD Advanced Nurse Practitioner (ANP) and CF dietitian, providing treatment advice tailored to patients’ blood glucose levels and dietary intake. We wished to assess our patients’ views of this new service. Methods: Using a structured questionnaire, we surveyed 30 patients with CFRD (14 male) in the first 6 months since the service started. Results: Twenty eight patients(97%) rated the new service as “good” or “excellent” in helping them understand and manage their CFRD, and 26 (90%) felt able to ask questions freely. Five patients (16%) felt that changes to treatment could have been explained more clearly, but the remainder were satisfied. Other comments included “excellent chance to understand how blood sugars are affected when taking other medication and also dietary advice on eliminating excess sugar from my diet”, “staff approachable & supportive”, “hugely beneficial to see CF nurse/dietitian/diabetic nurse all together as matters can be discussed in more detail”, and “staff approachable & supportive”. Suggested improvements included allocating time slots in advance so patients could prepare blood sugar charts to help with changes. Conclusion: Our new and innovative MDT approach to the inpatient management of CFRD is well liked by patients, essential when patient involvement is necessary to ensure satisfactory glycaemic control and good outcomes. We recommend this service to other adult CF units, where CFRD is an increasingly common complication of this complex disease.
257 Administering the PHQ8 and GAD7 in routine UK CF care: in situ utilisation in a paediatric and an adult centre A.J.A. Duff1 , G. Bowmer2 , R. Waldron1 , S. Cammidge3 , D. Peckham3 , G. Latchford4 . 1 Regional Paediatric CF Unit, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom; 2 Department of Clinical & Health Psychology, Leeds, United Kingdom; 3 Regional Adult CF Unit, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom; 4 Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
260 Quality improvement program (QIP) for adolescents in Paris Robert Debre´ (RD) CF Centre
Objectives: A key recommendation of the ECFS/CFF Mental Health (MH) Guidelines Group is to administer brief depression and anxiety questionnaires to CF patients 12 years and at least 1 parent during annual assessment. This study piloted utlisation and incorporation into electronic patient records. Methods: Parents and adults with CF completed the PHQ8, GAD7 and gave feedback on the process during routine clinic visits. Scoring occurred within 7 days of completion and recorded electronically. Caseness triggered follow-up assessment by a clinical psychologist. Results: See the table. Participants’ feedback indicates that thus far, 70% agree with the ECFS/CFF MH guidelines, many parents commenting that they were ‘excellent’. The majority (66% and 57% respectively), felt that the PHQ8 and GAD7 captured their feelings and agreed that they should be administered on annual review. To date all parent comments have been positive with only 1 negative view being expressed by a patient. PHQ8
GAD7
Parents
Adult patients
Parents
None
21
10
22
Adult patients 10
Mild
14
3
12
2 0
Moderate
5
1
3
Moderate/Severe
2
0
N/A
N/A
Severe
2
0
7
2
Total
44
14
44
14
Conclusion: This is an on-going study piloting in situ implementation of MH screening guidelines and includes parent/patient views on recommendations and proposed care pathways. Full results and thematic analyses of narrative responses will be reported with consideration given to future electronic administration and scoring.
M. Gerardin1 , A. Vital Foucher1 , A. Pesle1 , S. Gonsseaume1 , S. Catto1 , A. Munck1 . 1 Hˆopital Robert Debr´e CF Centre AP-HP Universit´e Paris7, Paris, France French QIP Phare-M was introduced in France in 2011 in order to optimize patients’ outcomes, increase satisfaction of both patients and professionals. Paris RD CF center participated in its pilot phase in 2011. Objective: Our theme of improvement was FEV1% in 13−17 years whose median was below the national median (2009 French Patient Registry report). Primary objective was to improve it by 5% from Sep 2011 to the end of 2013. Secondary objectives included development of i. adapted physical activity (APA) ii. instrumental physiotherapy iii. patient therapeutic education iv. realization of a dream. Methods: We focused our efforts on adolescents with FEV1 <80%. The MDT used a fishbone to analyse each patient situation and assess their needs and barriers influencing FEV1. A personalized action plan was defined and aimed at the four secondary objectives, discussed with the patient, set up and followed up. Results: Median FEV1 of all adolescents 13−17 years was 83% in 2011(n = 40), 90.6% in 2012 (n = 39), 92.5% in 2013 (n = 37). Those with FEV1 <80% (n = 18) were involved in the QIP. Their median FEV1 was 55.5% in 2011, 59% in 2012 (n = 18) and 65.5% in 2013 (n = 16). At the end of 2013, the secondary objectives were also achieved for most “QIP” patients: use of instrumental support (n = 14); APA coaching (n = 15); realization of a dream (n = 5). Some non “QIP” patients also benefited from the APA coaching or instrumental support. Conclusion: QIP has mostly achieved the goals set for the first three years, and helped to initiate a team dynamic and a continuous improvement process. This will continue and extend to the field of nutrition.
11. Nursing/Psychosocial/Quality Improvement
Posters
256 Understanding the psychological difficulties patients with cystic fibrosis share at annual review
259 Improving inpatient cystic fibrosis related diabetes (CFRD) care: The patients’ perspective
K. James1 , S. Phillips1 . 1 University Hospitals Bristol NHS Foundation Trust, Bristol Royal Hospital for Children, Psychological Health Services, Bristol, United Kingdom
S. Pandya1 , P. Dyce2 , M.J. Walshaw2 . 1 Liverpool Heart and Chest Hospital, Nutrition and Dietetics, Liverpool, United Kingdom; 2 Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
Objectives: Psychological assessment at annual review has been recommended as part of psychologists roles within CF teams in the UK. Due to service constraints, the clinical psychology service within Bristol Adult Cystic Fibrosis Centre (BACFC) currently adopts a questionnaire-based approach for annual psychological assessments. An audit of these questionnaires aimed to identify the proportion of patients completing the annual psychological assessment and to understand the psychological difficulties patients within BACFC reported experiencing. Methods: An audit of patients’ responses (n = 91) to the annual psychological assessment questionnaire from January 2014 to December 2014 was completed. Results: 42% of patients within the service completed the questionnaire. The most frequently reported difficulty was stress (43%, n = 39), followed by anxiety or worry (33%, n = 30), and low mood (26%, n = 24). 23% (n = 21) of patients indicated that managing all of their treatments was causing significant problems. Patients described a range of goals related to health and wellbeing for the next year ahead. Conclusion: This audit suggests that a significant proportion of CF patients at BACFC report experiencing stress, worry and low mood, and difficulties managing all of their treatments. Furthermore, given the completion rate, the annual psychological assessment process may need to be reviewed in order to be accessible to a wider group of patients.
Objectives: In CFRD, tight glycaemic control is important, particularly when patients are undergoing IV antibiotic therapy. To facilitate this, we have developed a dedicated weekly ward round led by a CFRD Advanced Nurse Practitioner (ANP) and CF dietitian, providing treatment advice tailored to patients’ blood glucose levels and dietary intake. We wished to assess our patients’ views of this new service. Methods: Using a structured questionnaire, we surveyed 30 patients with CFRD (14 male) in the first 6 months since the service started. Results: Twenty eight patients(97%) rated the new service as “good” or “excellent” in helping them understand and manage their CFRD, and 26 (90%) felt able to ask questions freely. Five patients (16%) felt that changes to treatment could have been explained more clearly, but the remainder were satisfied. Other comments included “excellent chance to understand how blood sugars are affected when taking other medication and also dietary advice on eliminating excess sugar from my diet”, “staff approachable & supportive”, “hugely beneficial to see CF nurse/dietitian/diabetic nurse all together as matters can be discussed in more detail”, and “staff approachable & supportive”. Suggested improvements included allocating time slots in advance so patients could prepare blood sugar charts to help with changes. Conclusion: Our new and innovative MDT approach to the inpatient management of CFRD is well liked by patients, essential when patient involvement is necessary to ensure satisfactory glycaemic control and good outcomes. We recommend this service to other adult CF units, where CFRD is an increasingly common complication of this complex disease.
257 Administering the PHQ8 and GAD7 in routine UK CF care: in situ utilisation in a paediatric and an adult centre A.J.A. Duff1 , G. Bowmer2 , R. Waldron1 , S. Cammidge3 , D. Peckham3 , G. Latchford4 . 1 Regional Paediatric CF Unit, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom; 2 Department of Clinical & Health Psychology, Leeds, United Kingdom; 3 Regional Adult CF Unit, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom; 4 Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
260 Quality improvement program (QIP) for adolescents in Paris Robert Debre´ (RD) CF Centre
Objectives: A key recommendation of the ECFS/CFF Mental Health (MH) Guidelines Group is to administer brief depression and anxiety questionnaires to CF patients 12 years and at least 1 parent during annual assessment. This study piloted utlisation and incorporation into electronic patient records. Methods: Parents and adults with CF completed the PHQ8, GAD7 and gave feedback on the process during routine clinic visits. Scoring occurred within 7 days of completion and recorded electronically. Caseness triggered follow-up assessment by a clinical psychologist. Results: See the table. Participants’ feedback indicates that thus far, 70% agree with the ECFS/CFF MH guidelines, many parents commenting that they were ‘excellent’. The majority (66% and 57% respectively), felt that the PHQ8 and GAD7 captured their feelings and agreed that they should be administered on annual review. To date all parent comments have been positive with only 1 negative view being expressed by a patient. PHQ8
GAD7
Parents
Adult patients
Parents
None
21
10
22
Adult patients 10
Mild
14
3
12
2 0
Moderate
5
1
3
Moderate/Severe
2
0
N/A
N/A
Severe
2
0
7
2
Total
44
14
44
14
Conclusion: This is an on-going study piloting in situ implementation of MH screening guidelines and includes parent/patient views on recommendations and proposed care pathways. Full results and thematic analyses of narrative responses will be reported with consideration given to future electronic administration and scoring.
M. Gerardin1 , A. Vital Foucher1 , A. Pesle1 , S. Gonsseaume1 , S. Catto1 , A. Munck1 . 1 Hˆopital Robert Debr´e CF Centre AP-HP Universit´e Paris7, Paris, France French QIP Phare-M was introduced in France in 2011 in order to optimize patients’ outcomes, increase satisfaction of both patients and professionals. Paris RD CF center participated in its pilot phase in 2011. Objective: Our theme of improvement was FEV1% in 13−17 years whose median was below the national median (2009 French Patient Registry report). Primary objective was to improve it by 5% from Sep 2011 to the end of 2013. Secondary objectives included development of i. adapted physical activity (APA) ii. instrumental physiotherapy iii. patient therapeutic education iv. realization of a dream. Methods: We focused our efforts on adolescents with FEV1 <80%. The MDT used a fishbone to analyse each patient situation and assess their needs and barriers influencing FEV1. A personalized action plan was defined and aimed at the four secondary objectives, discussed with the patient, set up and followed up. Results: Median FEV1 of all adolescents 13−17 years was 83% in 2011(n = 40), 90.6% in 2012 (n = 39), 92.5% in 2013 (n = 37). Those with FEV1 <80% (n = 18) were involved in the QIP. Their median FEV1 was 55.5% in 2011, 59% in 2012 (n = 18) and 65.5% in 2013 (n = 16). At the end of 2013, the secondary objectives were also achieved for most “QIP” patients: use of instrumental support (n = 14); APA coaching (n = 15); realization of a dream (n = 5). Some non “QIP” patients also benefited from the APA coaching or instrumental support. Conclusion: QIP has mostly achieved the goals set for the first three years, and helped to initiate a team dynamic and a continuous improvement process. This will continue and extend to the field of nutrition.