Quality standard

Quality statement 6: Support to self-manage on a virtual ward

Quality statement 6: Support to self-manage on a virtual ward

Quality statement

Adults admitted to an acute respiratory infection virtual ward are supported to self-manage, including having a self-escalation plan.

Rationale

Providing support to help adults self-manage their symptoms and any long-term conditions when they are admitted to an acute respiratory infection virtual ward can prevent deterioration and future hospital admission. Including a clear self-escalation plan that details what to do if their health starts to deteriorate, or does not improve, will support patient safety. It will also help to provide reassurance that their care will be escalated, if needed.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Process

Proportion of adult admissions to an acute respiratory infection virtual ward where advice and information to support self-management was given.

Numerator – the number in the denominator where advice and information to support self-management was given.

Denominator – the number of adult admissions to an acute respiratory infection virtual ward.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.

b) Proportion of adult admissions to an acute respiratory infection virtual ward with a documented self-escalation plan.

Numerator – the number in the denominator with a documented self-escalation plan.

Denominator – the number of adult admissions to an acute respiratory infection virtual ward.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.

Outcome

Proportion of adults admitted to an acute respiratory infection virtual ward who felt they had enough support to manage their condition and knew what to do if they felt unwell.

Numerator – the number in the denominator who felt they had enough support to manage their condition and knew what to do if they felt unwell.

Denominator – the number of adults admitted to an acute respiratory virtual ward.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient surveys.

What the quality statement means for different audiences

Service providers (virtual ward providers) ensure that adults admitted to an acute respiratory infection virtual ward are supported to self-manage and have a self-escalation plan. They ensure that staff have access to information on self-management for specific conditions and are aware of and can refer to local services such as stop smoking support. They ensure staff have the skills to develop self-escalation plans to meet individual needs.

Healthcare professionals (such as doctors, GPs, nurse practitioners, advanced clinical practitioners, nurses, pharmacists and care navigators) provide advice and information to adults admitted to an acute respiratory infection virtual ward to support them to self-manage. This may include referral to other services such as stop smoking support. It will also include providing a self-escalation plan to the person and their family and carers, so they know what to do if their health deteriorates or does not improve.

Commissioners ensure that they commission acute respiratory infection virtual ward services that support adults to self-manage, including referral to other services such as stop smoking support, if needed, and providing a self-escalation plan. Commissioners ensure that appropriate escalation processes are in place to maintain patient safety, including out of hours support.

Adults admitted to an acute respiratory infection virtual ward receive advice and information to help them manage their symptoms and any long-term conditions while they are unwell. They have a personalised plan for what to do if they feel unwell, their symptoms get worse, or they are not improving.

Definitions of terms used in this quality statement

Acute respiratory infection virtual ward

These support personalised care for people with confirmed or suspected acute respiratory infections, including COVID‑19 and non-infective chronic obstructive pulmonary disease exacerbations, who are stable or improving but require acute level care and choose to be cared for at home. They do this by providing an alternative to a hospital admission and/or to support safe early discharge from hospital for people who require ongoing hospital monitoring and treatment. They require a combination of face-to-face care and digital technology in the place a person calls home, including care homes. [Adapted from NHS England's guidance note on virtual ward care for people with acute respiratory infection including chronic obstructive pulmonary disease, introduction section]

Support to self-manage

This will vary depending on individual needs and any long-term conditions, but may include:

  • advice to drink plenty of fluids

  • how to treat fever and cough with over-the-counter medications

  • how to minimise the risk of transmission of infection to others, including, respiratory and hand hygiene, and avoiding close contact with other (vulnerable) people

  • advice about smoking cessation, behavioural support, prescription, and referral

  • review and advice about vaccination (influenza, pneumococcal and COVID)

  • ensuring inhaler technique is optimal, if used

  • education about breathing techniques and chest clearance, if relevant

  • self-management education and use of rescue packs (prescribed corticosteroids and antibiotics for people with chronic obstructive pulmonary disease, if they are unwell)

  • advice about where to source further written information

  • referral to local self-help groups.

[GIRFT and NHS England's making the most of virtual wards, including hospital at home (2023), acute respiratory infection – cohorts and optimisation; NICE's guideline on tobacco: preventing uptake, promoting quitting and treating dependence, recommendations 1.14.5 and 1.14.6; and expert opinion]

Self-escalation plan

People admitted to an acute respiratory infection virtual ward and their carers should agree a person-held personalised escalation plan. On admission people should be given an information leaflet including clear information around escalation. Escalation may include calling the acute respiratory infection virtual ward telephone number, NHS 111/999 or out of hours, or attending their nearest emergency department. People in specific groups such as pregnant women and vulnerable adults should receive relevant safety netting and escalation advice. In the event of deterioration, the person-held escalation plan should assist remote assessment by NHS 111/999/acute respiratory infection virtual ward teams and help reduce inappropriate readmissions. [NHS England's guidance note on virtual ward care for people with acute respiratory infection including chronic obstructive pulmonary disease, appendix on acute respiratory infection pathway – stage 2: admission]

Equality and diversity considerations

People should be provided with information that they can easily read and understand themselves, or with support, so they can communicate effectively with healthcare services. Information should be in a format that suits their needs and preferences, including those who are digitally excluded and people with neurodiverse conditions. It should be accessible to people who do not speak or read English, and it should be culturally appropriate and age appropriate. People should have access to an interpreter or advocate, if needed. For people with additional needs related to a disability, impairment or sensory loss, information should be provided as set out in NHS England's Accessible Information Standard or the equivalent standards for the devolved nations.

Healthcare professionals should be aware that some people may need more support and information to enable them to self-manage while admitted to a virtual ward, for example, because of disability, mental health needs or socio-economic deprivation. Healthcare professionals should provide help to access mental health support, if needed, to people who have mental health needs and are admitted to an acute respiratory infection virtual ward.