Transcript Finchley Memorial Hospital

How can COPD Community Services
reduce hospital admissions?
Glenda Esmond
Respiratory Nurse Consultant
West Herts Community COPD Service
Causes of Emergency Admissions
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Exacerbations of COPD are a major cause of
hospital admissions
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It is estimated that only 50% of all COPD
exacerbations are reported
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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
Decline in lung function
Increased symptoms
(breathlessness)
Worsening health status
Increased risk
of hospitalization
Respiratory Failure
(GSF prognostic marker)
How to Reduce Admissions
Preventative care
 Early Management of exacerbation
 Recognition of palliative care needs
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Preventative Care
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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 MAINTENANCE
2 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 Led
MDT &
Telephone advice
HOSPITAL
at
HOME
Hospital at Home Outcomes
Breathlessness score pre & post
hospital at home
COPD Assessm ent Tool Pre & Post Hospital at Hom e
30
25
5
20
Pre
BORG
Scale
Post
Scale
3
Pre
Post
15
10
5
1
0
Hospital anxiety and depression Scores
Pre & Post Hospital at Hom e
20
15
Pre
HAD
10
Scale
5
0
Post
Recognising Palliative Care Needs
(essentially GSF prognostic indicators)
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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
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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.”
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Community COPD Pathway
PULMONARY
REHAB
PULMONARY
REHAB
ASSESSMENTS
HOME OXYGEN
ASSESSMENTS
PULMONARY
REHAB
PROGRAMME
HOME OXYGEN
FOLLOW-UP
PULMONARY
REHAB
MAINTENANCE
HOSPITAL AT
HOME
HOME
OXYGEN
EARLY
SUPPORTED
DISCHARGE
COMMUNITY
CLINICS
ADMISSION
AVOIDANCE
NURSE / AHP
CLINICS
HOSPITAL
AT HOME
REHAB
Home Exercise
SOCIAL
SERVICES
CONSULTANT
RESPIRATORY
PHYSICIAN
CLINICS
Including home visits
SELF
MANAGEMENT
PALLIATIVE
CARE