Emilie Maughan photo.jpg

Standardising the discharge process for paediatric home oxygen

A London-based discharge bundle that could be adopted by any region

Monday, July 2, 2018

  • Emilie Maughan is a WellChild Children’s Respiratory Specialist Nurse at Great Ormond Street Hospital. She specialises in Long Term Tracheostomy Ventilation with an interest in home oxygen services having managed the paediatric home oxygen patients at King’s College Hospital previously.
  • As Chair of the Paediatric Pan London Oxygen Group (PPLOG), Emilie has been focussing on leading a working group of paediatric Home Oxygen leads to improve quality and standardise the discharge process for children requiring home oxygen across London.

Hi Emilie, welcome to Respiratory Futures. How did your oxygen group and its contributors come together?

The PPLOG meets every 3-4 months with a focus on quality improvement for Paediatric Home Oxygen services. The group stemmed from the Adult London Oxygen Group, now the London Clinical Oxygen Network at which I represent Paediatric Services in London along with two other PPLOG members.

It’s mainly nurse-led with support from Ian Balfour-Lynn, Paediatric Respiratory Consultant at The Royal Brompton Hospital, author of the 2009 British Thoracic Society Paediatric Home Oxygen Guidelines and Caroline Lock, Clinical Educator at the current oxygen provider, Air Liquide.

The nurses represent North, South East and West London Paediatric Oxygen services and cover a range of settings with neonatal intensive care units, community teams and tertiary respiratory centres represented from boroughs across London.

What prompted the development of the bundle?

At an initial Oxygen meeting of Paediatric Nurses it became clear that the discharge process for children requiring home oxygen varied greatly, with some London areas offering high quality support and education to families prior to discharge and others less so. There was much debate as to who was responsible for each part of the discharge process, with community based teams insisting hospital teams take responsibility and hospital representatives suggesting it should be managed by community teams.

The PPLOG Discharge Bundle enables any registered nurse to utilise the Bundle when supporting a child that requires home oxygen.
Emilie Maughan

The solution was to create a working group of clinicians involved in the discharge process of children that require home oxygen, representative of the boroughs across London and also of neonatal, Community Nursing and Paediatric Respiratory Teams should create a document to help to standardise the discharge process for our Paediatric patients.

How did you begin?

First, a baseline survey was conducted to assess current provision and identify where clinicians felt a discharge bundle to standardise the process would be useful. There was an overwhelmingly positive response, with 97% of respondents stating that this would be helpful. It also highlighted current issues, with 53% reporting that education for parents/carers is inconsistent, with 40% of respondents not having a competency document for parents using the home oxygen with their children. 

We then collated the different discharge documents in use across London and reviewed the BTS Guidelines for Home Oxygen in Children (2009), NHS Primary Care Commissioning (2011) Home Oxygen Service – Assessment and Review: Good practice guide and NHS Quality Improvement Scotland (2010) Best Practice Statement: Home oxygen therapy for children being cared for in the community amongst other local guidelines and policies. From there we devised a set of documents to aid and standardise the discharge process as a whole, including education of clinicians and parents and follow-up of children requiring home oxygen across London.

The Bundle should follow the patient through their journey home, with copies being sent to relevant clinicians and filed in their notes. This enables families and carers to have ownership of their relative's discharge.
Emilie Maughan

This resulted in the Paediatric Pan London Oxygen Group Discharge Bundle, a set of 7 documents including a discharge Pathway process map detailing when and how each of the other 6 should be utilised within the discharge process.

The PPLOG Discharge Bundle was peer reviewed by all members of the Paediatric Pan London Oxygen Group and medical teams from each of the trusts. It was then reviewed and endorsed by the London Clinical Oxygen Network, The London Neonatal Operational Delivery Network and WellChild.

The PPLOG Discharge Bundle includes the following 7 documents:

  • Home Oxygen Discharge Pathway using PPLOG Discharge Bundle
  • Home Oxygen Discharge Planning Checklist (for completion by discharging centre, filed in notes and copy to CCNT)
  • Parent/ Carer/ Staff competencies (for completion by discharging centre, filed in patient notes and copy to the individual and the relevant CCNT)
  • Home Oxygen Risk Assessment Form Prior to Discharge, including Guidelines for completing the Home Oxygen Assessment (for completion by CCN, filed in CCN notes and copy to discharging centre and caregiver- including a copy to caregiver of the Guidelines used to complete the assessment)
  • Home Oxygen Home Visit Review Document (for completion at first home visit by CCN and at least annually thereafter)
  • Example Escalation Care Plan with or without Saturation Monitoring (either one for completion by discharging centre, filed in notes and copy to caregiver and CCNT)
  • Example Community Nursing Team Care Plan-Oxygen Therapy Management (for completion by CCN for filing in CCNT notes)
Heimlich valve
Members of PPLOG at the Healthcare Transformation Awards where they were finalists for the Primary Care Innovation Award

Who can use the bundle?

The PPLOG Discharge Bundle is being rolled out for use across London. However, we hope that this can be used more widely across the UK to improve the discharge process for children requiring home oxygen, standardising the process nationally and ensuring high quality of care.

How is this benefiting clinicians and patients?

We are in the process of surveying the impact on both families and clinicians following the role out of the PPLOG Discharge Bundle across London. Demand for this has been huge with all 60 places on our July study day being filled within 24 hours and a second study day on 19th October 2018 is almost at capacity.

The PPLOG Discharge Bundle enables any registered nurse to utilise the Bundle when supporting a child that requires home oxygen (and their family/carers) through a high quality discharge process. It helps ensure that education is thorough, communication between the discharging centre and the community team is improved and no elements of the discharge are missed. It is simple, effective and adaptable.

What advice do you have for people using the discharge bundle or wanting to set up something similar?

The Bundle should follow the patient through their journey home, with copies of each section being taken and sent to relevant clinicians and filed in their notes. This enables families and carers to have ownership of their relative's discharge, hopefully empowering them to be more involved and have the knowledge of the steps to be undertaken before they are safe to go home.

I would encourage anyone that identifies a process issue or an area for improvement within services to step up and make a change. It just requires someone to start the ball rolling.

I am proud of how far our working group has come, becoming finalists for the Primary Care Innovation Award at the Healthcare Transformation awards 2018 and also being shortlisted for the Nursing Times Award 2018 under the Respiratory Nursing category. It takes a lot of work to innovate but it is worth it when you see the results and the improvements to the patient experience and quality of care.

The Paediatric Pan London Oxygen Group Discharge Bundle is available to download via the Respiratory Futures Resources area.

If you have any questions about this work please contact us or leave a comment below.