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.