© Grey Bruce Health Network COPD Education Workshop (click to go to the desired section) Introduction to Workshop/Instructions Evidence-Based Care Program COPD WorkshopWorkshop

© Grey Bruce Health Network Introduction This interactive workshop is designed to go along with a copy of the pathway. Keep the pathway handy as you go through the workshop to engage in the required activities. This is a web-based workshop, and thus has links throughout each page to enable you to move throughout the workshop. Whenever you see words underlined like this, you can click on that area to go to another section or to find more information on a topic.underlined like this At the bottom of each page are navigational buttons to help you move through the workshop. You can go through as much or as little of the workshop as you like at a time. If you have any questions about how to use this workshop or the individual pathways, feel free to ask your Site Champion or contact the Evidence-Based Care Program. Back to Start of Workshop NextBack

© Grey Bruce Health Network Evidence-Based Care Program These pathways have been developed as a part of the Evidence-Based Care Program, which is Schedule 6 in the agreement of the Grey Bruce Health Network. The intent is to develop clinical pathways and other evidence-based care tools based on clinical practice guidelines, that flow across all hospitals and community services in Grey and Bruce (including Grey Bruce Health Services, Hanover and District Hospital, South Bruce Grey Health Centre, Grey Bruce Public Health and the Community Care Access Centre). It is hoped that these pathways will improve: Coordination of care through more communication across professions; Continuity of care, through increased linkages among hospitals and the CCAC; Clinical outcomes, through increased usage of best practices;and Patient satisfaction, through linked expectations and increased patient teaching at our agencies. Back to Start of Workshop NextBack

© Grey Bruce Health Network COPD Pathway Package This pathway is for patients who are admitted with the diagnosis of Chronic Obstructive Pulmonary Disease The pathway consists of 7 parts: Clinical Practice Guideline Pre-Printed Orders Clinical Pathway Patient Pathway Patient Education Materials Teaching Checklist Back to Start of Workshop Back to beginning of COPD section NextBack

© Grey Bruce Health Network COPD Clinical Practice Guideline This guideline is the Global Initiative for Chronic Obstructive Lung Disease (2005) This guideline summarizes the strategy for diagnosis,management, and prevention of Chronic Obstructive Pulmonary Disease used in the development of this pathway. It can be found electronically on the GBHN website – Back to Start of Workshop Back to beginning of COPD section NextBack

© Grey Bruce Health Network COPD Pre-Printed Orders These orders are to be initiated in emergency once a patient is admitted with COPD. A sample can be found by clicking here.clicking here These orders can be found in the ER and on the unit by going to the website you will find a shortcut on your desktop Evidence-Based Care Program that will bring you to the website Back to Start of Workshop Back to beginning of COPD section NextBack

© Grey Bruce Health Network Patient Materials This package has a patient pathway, which explains to the patient what is happening to them while in hospital. (see sample)(see sample) It should be given to the patient early in the hospital stay and used to explain the care to the patient. Also, there is a teaching checklist, which should be put on the chart and used to track what education has been done with the patient and what is left to cover before the patient is discharged. You should be familiar with these topics, if not you should look through the reference materials listed for each topic. (see sample)(see sample) The reference materials for the teaching checklist are Deep Breathing and Coughing Handout (see sample) and Inhaler Checklist (see sample), Smoking Cessation Flowchart (see sample), The Breath Works Plan Booklet and the Canadian Cancer Society – Smoking Booklets.( must be ordered )(see sample) Back to Start of Workshop Back to beginning of COPD section NextBack

© Grey Bruce Health Network COPD Clinical Pathway COPD is a Phase-Type clinical pathway with a 5 day estimated length of stay. Click here to see the pathway.Click here It has two phases. The patient moves from one phase to the next by achieving the Patient Outcomes at the top of the page. Once these are achieved, the patient can move to the next phase. If the outcome is not achievable due to patient complications or we are not able to resolve move the patient to the next phase of the pathway. If the outcome will need more time to achieve continue in the same phase with a new blank page that can be printed from Back to Start of Workshop Back to Pathway Components NextBack

© Grey Bruce Health Network COPD As with the other pathways, using the column for your shift, initial tasks as they are completed, or enter N/A and initial if they are not applicable to the patient. For example, if it is the night shift and you are not doing any patient teaching, indicate N/A and initial in the section for Psychosocial/Education under “Review Patient Pathway” and “Review Teaching Checklist”. The emphasis is on achieving patient outcomes to move from each phase Throughout each of the Phases refer and complete the Discharge Criteria page. Discharge Criteria Phase 2 is approximately 3 days Back to Start of Workshop Back to beginning of COPD section NextBack

© Grey Bruce Health Network COPD The Discharge Criteria, the last page of the pathway, should be checked daily. If any of the criteria have been met, these should be initialed and dated. Once the Discharge Criteria have been met, the patient should be ready to go home. If a patient is transferred to another Hospital send copies of the Discharge Criteria, MAR Sheet and the Teaching Checklist to assist in the transition of care Back to Start of Workshop Back to beginning of COPD section NextBack

© Grey Bruce Health Network End of COPD pathway section This is the end of the general information for the COPD pathway. To get further information by trying the pathway on a sample patient, move to the Simulation portion of the COPD workshop.Simulation Test your knowledge of the COPD pathway by doing the COPD quiz. quiz. Back to Start of Workshop NextBack Back to beginning of COPD section

© Grey Bruce Health Network Simulation Try it! Take a look at the pathway for the simulation.Take a look Nancy, arrives in hospital, she has a history of COPD and the physician determines she should be admitted. She then fits the criteria to be put on the COPD pathway - find the inclusion criteria on the first page of the pathway. The pre-printed orders for COPD should be pulled for the physician to use.pre-printed orders The pathway should be started in Emergency, as this is where the care begins. If the patient is directly admitted from the physician’s office, the pathway can be started on the unit. The clinical pathway and teaching checklist goes on the chart, and the patient pathway and patient education materials are given to her daughter as Nancy is exhausted.teaching checklist patient pathway Take a look at the clinical pathway. On the first page is a master signature sheet. Sign it, and then for the remainder of the pathway you can just initial as tasks are complete (if you have a Master Signature Sheet for your facility, this will not be on your pathway page). Back to Start of Workshop Back to beginning of COPD section NextBack

© Grey Bruce Health Network Simulation Cont’d There are also some basic instructions on the first page on how to use the pathway. Each page will need a patient ID sticker. Flip to the first page of the pathway, “Phase 1”: On the first page of each pathway will be a section for comorbid conditions. Please list any conditions the patient has other than COPD, that may affect the care you are giving. This will help health records in coding Nancy appropriately. This page is used for the first day Nancy is in hospital. You will see six columns on the right hand side (one for each shift – if there are only two 12 hour shifts, you will only need two of these) per 24 hr period –write in today’s date at the top). Below the date, write in the hours you will be caring for Nancy. You will then use this column to initial as each task on that page is completed. You can use your corporate progress notes if you require further documentation. Back to Start of Workshop NextBack Back to beginning of COPD section

© Grey Bruce Health Network Simulation Cont’d The first section of Phase 1 is the Patient Outcomes. Decreased respiratory rate Decreased heart rate Decreased temperature Dyspnea scale score improving Saturations achieved with less oxygen (flow or %) Back to Start of Workshop NextBack Back to beginning of COPD section

© Grey Bruce Health Network Simulation Cont’d The rest of the page, lists the tasks that should be completed during the first day. For example, under assessments, Vitals should be taken QID and PRN. Initial in the column to the right that corresponds to your shift as each task is completed. Some tasks are not appropriate for all patients or all time frames. In these cases, you can indicate an N/A and initial to show this. (see a sample page completed)(see a sample page completed) Back to Start of Workshop NextBack Back to beginning of COPD section

© Grey Bruce Health Network COPD Chest Assessment Form The Chronic Obstructive Pulmonary Disease Chest Assessment Documentation Form is similar to the regular Chest Assessment Form except that it includes a place to record Dyspnea Score. (see a sample page completed)(see a sample page completed) On the back of the page you will find the legend W- Wheezes C- Crackles A- Absent Breath Sounds Back to Start of Workshop NextBack Back to beginning of COPD section

© Grey Bruce Health Network Simulation Cont’d By the end of the 2 nd day of Nancy’s admission she is breathing much easier and she has met all of the patient outcomes for this phase so she can move to Phase 2 for the next shift. ( she does not need to stay in the Phase 1 for 2 days) Back to Start of Workshop NextBack Back to beginning of COPD section

© Grey Bruce Health Network Simulation Cont’d Flip to the next page of the pathway, which is used for Phase 2 of Nancy’s hospital admission. It works the same as the first page. Be sure to indicate the date and time you are caring for Nancy at the top of each column. The top section is for patient outcomes. These are goals we are looking to meet for the next timeframe, in this case the remainder of the 2 nd day. The rest of the sections are tasks that are to be completed for that day. Again, some tasks are not applicable to each patient, or to each shift. For example, if it is night shift, you may not be teaching Nancy, so under “Psychosocial Support/Education”, you can indicate “N/A” and initial “Review Patient Pathway” and “Start Teaching Checklist”. On each day of all pathways, you will notice a referral to a Teaching Checklist and a Patient Pathway. Back to Start of Workshop NextBack Back to beginning of COPD section

© Grey Bruce Health Network Simulation Cont’d The Teaching Checklist should be on the chart and be filled in as topics are covered with Nancy. This way the next nurse on shift will know what has been covered and can continue down the list. The Patient Pathway should also be given to the patient. However, if Nancy is not ready for education, indicate N/A and initial these tasks until she is ready for education.Teaching Checklist Patient Pathway The education materials, can be referenced to aid you in teaching. Also, the Patient Pathway should be referred to on a daily basis to help Nancy understand the plan of care.. The reference materials for the teaching checklist are Deep Breathing and Coughing Handout (see sample) and Inhaler Checklist (see sample), Smoking Cessation Flowchart (see sample), The Breath Works Plan Booklet and the Canadian Cancer Society – Smoking Booklets.( must be ordered )(see sample) (see sample) see sample) Back to Start of Workshop NextBack Back to beginning of COPD section

© Grey Bruce Health Network Simulation Cont’d At the end of each day, in the Discharge Planning section (last section of each page), you will notice it says “Assess Discharge Criteria Daily”. This means you will need to flip to the last page of the pathway, the Discharge Criteria, on a daily basis, at some point during the day, and check if any of these goals have been met. If they have, initial and date them. Once all of these criteria have been met, Nancy is ready to go home Let’s assume it is admission day 3 and we are into Phase 2 of the pathway, and Nancy has achieved all the Discharge Criteria. As soon as these criteria have been met, she can go home. Back to Start of Workshop NextBack Back to beginning of COPD section

© Grey Bruce Health Network Simulation Cont’d If Nancy is transferred to another hospital, refer to the first page of the pathway under “How to use the Clinical Pathway” there is a list of documents to forward to the receiving hospital, so they can continue using the pathway. Back to Start of Workshop NextBack Back to beginning of COPD section

© Grey Bruce Health Network COPD Quiz 1. What are the inclusion/exclusion criteria for this pathway? 2. What patient education materials are used for this pathway? 3. What do you do with the teaching checklist? 4. What type of a pathway is this A) Day B) Phase ? Back to Start of Workshop Back Answers

© Grey Bruce Health Network Answers: COPD Quiz 1. What are the inclusion/exclusion criteria for this pathway? This pathway is applicable to those patients who have COPD, defined on the front of the pathway. 2. What patient education materials are used for this pathway? The reference materials for the teaching checklist are Deep Breathing and Coughing Handout and Inhaler Checklist, Smoking Cessation Flowchart (see sample), The Breath Works Plan Booklet and the Canadian Cancer Society – Smoking Booklets.( must be ordered ) 3. What do you do with the teaching checklist? This goes on the chart and is used to keep track of what education has been done. This sheet should be completed before the patient is discharged. 4. What type of a pathway is this A) Day B) Phase ? This is a Phase type pathway, the patient is to achieve outlined outcomes before moving to the next phase unless it is determined that they are not achievable. If you have had difficulty with any of these questions, go back through the material on this pathway and/or the general pathway information in this workshop. Ask your Site Champion or contact the Evidence-Based Care Program for any other questions you have. Back to beginning of COPD section Back to Start of Workshop Back