Table 1

Quality indicators for SDPs and non-invasive ventilation

Quality indicators for SDPQuality indicators for NIV
There are clear written criteria for acceptance on to SDPsNIV is used as the treatment of choice for persistent hypercapnic ventilatory failure during exacerbation despite medical therapy
The scheme is run by individuals who are capable of working independently and includes those specifically trained in respiratory medicineNIV is delivered in settings that are suitable for patients with COPD; that is, a designated area where staff have been specifically trained in NIV, for example ICU, HDU, emergency admissions unit or a dedicated respiratory ward
There is a named clinician responsible for the serviceThere is a named consultant responsible for the NIV service
There are clear protocols of care for the patients under the SDPThere is an ongoing inter-professional training programme for all staff involved in the care of patients established on NIV
Patients accepted for SDPs are entered onto a pulmonary rehabilitation scheme, patients not accepted onto the scheme still receive a package of written smoking cessation/educational supportNurses and doctors outside of specialist respiratory wards do know how to manage patients with COPD and are aware of the indications for and benefits of NIV
All patients with COPD and their carers receive written information about the SDP that describes what it is, and the support that is available well in advance of them needing the serviceThere is a written protocol that defines the monitoring of patients receiving NIV, and includes a minimum of regular clinical assessment, pulse oximetry and arterial blood gas measurements
The SDP has good lines of communication to manage patient care together with their GPThere is a clear set of individualised written instructions for management of each patient receiving NIV, including what to do in the event of deterioration and agreed ceilings of therapy, along with an agreed protocol between ICU and the medical teams for escalation of NIV to ICU with invasive ventilation
There are clear clinical links between SDPs and various members of the primary care teamLocally adapted written protocols for the management of patients with COPD requiring NIV, including weaning from NIV, are available in all relevant clinical areas for all relevant staff
There is continuous data collection along with prospective and annual audits of the service to monitor its effectivenessA selection of nasal and full face masks, types and nasal pillows are available; all areas offering NIV provide written information for patients about the indications for and patient experience of NIV
There is a written policy for providing patient information about NIV to patients with severe while in a stable state, for example, in an outpatient setting or upon discharge from hospital
There is an annual audit of the use of NIV, including all clinical areas; this audit covers patients offered NIV to examine its appropriate use and those that might have benefited from NIV but who were not provided with this therapy
  • COPD, chronic obstructive pulmonary disease; HDU, high dependency unit; ICU, intensive care unit; NIV, non-invasive ventilation; SDP, supported discharge programme.