Non- Invasive Ventilation - Improving outcomes and patient experience with understanding

North West LondonRespiratory
Start Date: 1 Oct 2016 End Date: 31 Mar 2018

Non- Invasive Ventilation - Improving outcomes and patient experience with understanding

The aim is to improve the quality of care for patients requiring acute NIV by improving patient/carer experience of NIV through understanding and engagement; and by improving staff awareness of patient perspective through a holistic approach to NIV education. A primary driver of the project is the development and implementation of an NIV bundle to ensure excellent NIV delivery and improve outcomes. 


About Non-Invasive Ventilation

Three million people in the UK live with Chronic Obstructive Pulmonary Disease (COPD), the fifth leading cause of death.

COPD is an umbrella term used to describe progressive lung diseases including emphysema, chronic bronchitis, and refractory (non-reversible) asthma. This disease is characterised by increasing breathlessness.

Non-invasive ventilation (NIV) is currently the most effective treatment for acute respiratory failure, reducing mortality by 50% but many patients found the experience of NIV stressful and frightening, resulting in lower use of the procedure. 

National and local evidence shows NIV treatment is often sub-optimal leading to poorer outcomes and patient experience.

To create better outcomes, this project aimed to improve quality of the acute NIV service at Imperial College NHS Trust (ICHT) by translating evidence-based guidance into action-oriented interventions including an algorithm to ensure NIV is prescribed correctly. A patient-centred NIV care bundle, driven by patients’ needs, was created and a decision algorithm that would help facilitate conversations between patients and staff. Two educational videos were created.

What Happened?

In the study, 301 episodes of NIV treatment at ICHT were undertaken. Over the study period, NIV episodes managed in an appropriate setting increased from a median of 91% to 100%, ceiling of care discussion improved from 77% to 89%, and NIV episodes where a parameter plan was followed improved from 50% to 76%Over 220 NIV care bundles have been completed since 2016 across two sites. A total of 70% completion rate. This work is a NICE published example of shared learning about implementing standards.

Dr William Oldfield