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COPD -Review of ‘At Risk Patient’

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1 COPD -Review of ‘At Risk Patient’
Mary Twitchett RGN MSc MSt (Cantab) Advanced Nurse Practitioner Dr Gant and Partners 114 Arbury Rd Cambridge

2 COPD ‘At Risk’ Patients Who Are They ?
Hospital admission for COPD > 2 Exacerbations per year > 2 courses of steroids a year Severe COPD MRC score 4-5 ( ? 3) CAT Score > 20 Mild COPD patient COPD patient with low psychological profile Housebound

3 Key Factors of Review COPD review : usual review of patient as done at annual review Assessment tools –MRC/ DOSE/ CAT score Smoking / Inhaler technique/ Pulmonary rehabilitation Oxygen sats when well Self Management Plan Exacerbation Pack Advise out of hours DOCUMENTATION

4 Managing stable COPD Patient with COPD Assess symptoms/problems
Manage those that are present as below Patients with COPD should have access to the wide range of skills available from a multidisciplinary team Smoking Breathlessness & exercise limitation Frequent exacerbations Respiratory failure Cor pulmonale Abnormal BMI Chronic productive cough Anxiety & depression Palliative care 4

5 “ Patient Myths” “My shortness of breath is just old age.”
“There’s nothing my doctor can do except tell me to quit smoking.” “If I rest more, it will get better.” “It’s my own fault – I don’t want to bother them “

6 Practitioners challenges
Build a relationship/ partnership Empathy Role with ambivalence Challenge Thoughts Goal set Follow up

7 What are the questions? 7 Take-home message
The final tool contains 8 items, covering: Cough Phlegm Chest tightness  Breathlessness going up hills/stairs  Activity limitation at home  Confidence leaving the home  Sleep and energy Supporting points1 Patients read the two statements for each item, which describe the best and worst scenario, and decide where on the scale (0-5) they fit. Scores for each of the 8 items are summed to give single, final score (minimum 0, maximum 40) – this is a measure of the overall impact of a patient’s condition on their life. Also, scores for the individual items within the questionnaire will provide insight into the relative influence that the different components of COPD have on its overall impact on a patient’s life – thus, they will highlight problematic areas, which can be explored further during consultation and ultimately addressed through intervention. References 1 COPD Assessment Test Healthcare Professional User Guide: Expert Guidance on frequently asked questions. Jones PW, Jenkins C, Bauerle, O (on behalf of the CAT Development Steering Group). Issue 1: September 2009 Reproduced from: COPD Assessment Test Healthcare Professional User Guide 7

8 Multidisciplinary working
COPD care should be delivered by a multidisciplinary team that includes respiratory nurse specialists Consider referral to specialist departments (not just respiratory physicians) Specialist department Who might benefit? Physiotherapy Advice about excessive sputum Dietetic advice People with BMI that is high, low or changing over time Occupational therapy People needing help with daily living activities Social services People disabled by COPD Multidisciplinary palliative care teams People with end-stage COPD (and their families and carers) NOTES FOR PRESENTERS: Please refer your audience page 14 of the QRG for more information on Referral for specialist advice and possible reasons for making a referral. Also, refer to page 15 of the QRG for follow-up and review of people with COPD in primary care. Related recommendations : The following functions should be considered when defining the activity of the multidisciplinary team: assessing patients (including performing spirometry, assessing the need for oxygen, the need for aids for daily living and the appropriateness of delivery systems for inhaled therapy). care and treatment of patients (including non-invasive ventilation, pulmonary rehabilitation, hospital-at-home/early discharge schemes, providing palliative care, identifying and managing anxiety and depression, advising patients on relaxation techniques, dietary issues, exercise, social security benefits and travel). advising patients on self-management strategies identifying and monitoring patients at high risk of exacerbations and undertaking activities which aim to avoid emergency admissions advising patients on exercise education of patients and other health professionals. [ ] It is recommended that respiratory nurse specialists form part of the multidisciplinary COPD team. [ ] [2004] 8

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