How can COPD Community Services reduce hospital admissions? Glenda Esmond Respiratory Nurse...
Transcript of How can COPD Community Services reduce hospital admissions? Glenda Esmond Respiratory Nurse...
How can COPD Community Services reduce hospital admissions?
Glenda EsmondRespiratory Nurse Consultant
West Herts Community COPD Service
Causes of Emergency Admissions
Exacerbations of COPD are a major cause of hospital admissions
It is estimated that only 50% of all COPD exacerbations are reported
A higher exacerbation rate is linked to:a more rapid decline in health status a faster decline in lung function more chronic respiratory symptoms
Anxiety caused by breathlessness
Effect of COPD Exacerbations
Increased symptoms (breathlessness)
Increased risk of hospitalization
Respiratory Failure(GSF prognostic marker)
Decline in lung function
Worsening health status
How to Reduce Admissions
Preventative careEarly Management of exacerbation Recognition of palliative care needs
Preventative Care
Flu & pneumococcal vaccination Smoking cessation Advice on exercise Advice on nutrition Self-management plan + rescue pack Assess for anxiety and depression
Pulmonary Rehabilitation
EXERCISE EDUCATION EXERCISE or MAINTENANCE2 sessions per week for 6 weeks
• 1 hour exercise• 1 hour education
smoking cessation medication & inhaler technique
management of exacerbations self-management breathing control & airway
clearance nutrition
relaxation & energy conservation
Maintenance sessions
Hospital at Home(Early recognition & Effective support)
Consultant LedMDT &
Telephone advice
HOSPITAL at
HOME
1
3
5
BORG Scale
Breathlessness score pre & post hospital at home
Pre
Post
0
5
10
15
20
25
30
Scale
COPD Assessment Tool Pre & Post Hospital at Home
Pre
Post
0
5
10
15
20
HADScale
Hospital anxiety and depression Scores Pre & Post Hospital at Home
Pre
Post
Hospital at Home Outcomes
Recognising Palliative Care Needs (essentially GSF prognostic indicators)
Surprise question is ‘I will not be surprised if the patient dies in the next 6 months
House bound Continuous oxygen +/- nebs Symptoms signs of right heart failure Recurrent exacerbations / hospital admissions Using NIV or not appropriate for NIV
Type II Respiratory Failure
> 6 weeks use of systemic steroids in the proceeding year or unable to reduce
Quality v Quantity
“Do everything to keep me alive”“Do everything to keep me comfortable.”
PULMONARY REHAB
COMMUNITY CLINICS
HOSPITAL AT HOME
HOSPITAL AT HOME
HOMEOXYGEN
PULMONARY REHAB
ASSESSMENTS
PULMONARY REHAB
PROGRAMME
PULMONARY REHAB
MAINTENANCE
HOME OXYGENASSESSMENTS
HOME OXYGEN FOLLOW-UP
ADMISSION AVOIDANCEADMISSION AVOIDANCE
HOSPITAL AT HOME
HOSPITAL AT HOME
REHABHome Exercise
REHABHome Exercise
SELF MANAGEMENT
SELF MANAGEMENT
CONSULTANT RESPIRATORY
PHYSICIAN CLINICS
NURSE / AHPCLINICS
Including home visits
PALLIATIVE CARE
PALLIATIVE CARE
SOCIAL SERVICESSOCIAL
SERVICES
EARLY SUPPORTED DISCHARGE
EARLY SUPPORTED DISCHARGE
Community COPD Pathway