Chronic Obstructive Pulmonary Disease (COPD) Discharge Care Bundle: Self-Management Education

Friday, March 27, 2020

Kimberly L. Graham, DNP1
Lenora Smith, PhD2
Willie H. Smith Jr., MD1
(1)Emory University Hospital Midtown, Atlanta, GA, USA
(2)College of Nursing, University of Alabama in Huntsville, Huntsville, AL, USA

Purpose:

The impact of chronic obstructive pulmonary disease (COPD) expenditure on the U.S. health system is $49.6 billion, and 23% accounts for hospital readmission (Harris, 2016). The fourth leading condition for 30-day readmission is COPD (Parikh, Shah, & Tandon, 2016). Less than thirty-day COPD readmissions occur due to knowledge deficit and lack of recognition of exacerbation symptoms (Harris, 2016). The purpose of this quality improvement project (QI) was to develop and implement a COPD discharge care bundle that will increase nursing’s effectiveness to prepare the soon-to-be-discharged COPD patient with self-management skills that will reduce the rate of hospital readmissions. The hospital participating in the quality improvement project has disease-specific education for stroke and heart failure patients. However, the COPD patient population admitted to the hospital did not have a specific discharge preparation education plan. The COPD education provided was unstructured, varied in content, and inconsistent from nurse to nurse throughout the hospital.

Methods:

Research studies discussed by (Hopkinson et al., 2012; Ospina et al., 2016) have focused on designing and developing COPD care bundles which used evidence-based interventions and practice in a structured manner to prepare patients to transition home. Registered nurses from three medical units were recruited to complete the pre-post Bristol COPD knowledge questionnaire and Nursing COPD Patient Discharge Education Survey. Next, 30-40 minute education sessions covering COPD and the self-management education bundle form were conducted. The education was delivered by a lecture with the aid of a PowerPoint presentation by the project leader. The nurses received as a handout the COPD discharge care bundle form. After the education sessions, the COPD discharge care bundle for self-management tool was implemented. At the end of eight weeks, the nurses completed a post-knowledge questionnaire and survey.

Results:

The Bristol COPD Knowledge Questionnaire (BCKQ) pre-and post-test results showed significant improvement in knowledge from 62% to 70% (n=21). The results of the post-Nursing COPD Patient Discharge Education Survey revealed 65% of the RNs (n=21) responded to having increased confidence to provide COPD education. The respondents were 55% confident, and 25% very confident with dyspnea management and exercise education. The readmission rate for the project was 17%, indicating clinical significance compared to the national COPD readmission rate of 20%.

Conclusion:

The bundle will provide the nursing staff with a structured process for COPD patient education and discharge preparedness that will improve COPD care outcomes. The nurse’s responses to the post-survey revealed acceptance of the structured COPD discharge bundle and increased confidence to provide self-management education. Implementing the bundle will promote interprofessional collaboration, improve COPD knowledge, and reduce hospital readmission rates.