Respiratory Care Practitioner; Continuum of Care for COPD Patient Susan Pfanner, CRT OHVI Cardiovascular Wellness & Rehabilitation

Objectives for the New RCP

 Improve ability to communicate with patient, other caregivers what outpatient pulmonary rehabilitation and Better Breathers Clubs are.

 Increase understanding of pulmonary rehabilitation’s role in the discharge planning and coordinated care model.

Respiratory Therapists

 Begin with first assess & evaluation  From ER to Medical Floor to Home/SNF or Rehabilitation  Where do patients go to regain strength and get back to living life?

Talking with your patient

 Recovering from a hospitalization often means adjusting lifestyle.  When providing care, you have an opportunity to share a bit of yourself as their respiratory therapist.  Help them to understand what to anticipate.

Discharge Planning for the RCP

 Be a team player  Be a good listener  Be an assessor  Make no assumptions  Be ready to learn  Document in chart/EMR  Be an educator  Pay attention to details  Begin with end in sight

Patients at each hospital who reported that YES, they were given information about what to do during their recovery at home

MCKENZIE-WILLAMETTE MEDICAL CENTER 88% SACRED HEART MEDICAL CENTER – RIVERBEND 84% MERCY MEDICAL CENTER 81% SALEM HOSPITAL SAMARITAN ALBANY GENERAL HOSPITAL 85% 83%

Medicare hospital compare (HCAHPS) Data collected 7/1/2010-6/30/2011; U.S. Department of Health & Human Services

This result is a ratio calculated by dividing the amount Medicare spends per patient for an episode of care initiated at this hospital by the median (or middle) amount Medicare spent per patient nationally.

Spending per Hospital Patient with Medicare MCKENZIE-WILLAMETTE MEDICAL CENTER 0.91

SACRED HEART MEDICAL CENTER-RiverBend MERCY MEDICAL CENTER SALEM HOSPITAL 0.92

0.87

0.91

SAMARITAN ALBANY GENERAL

Medicare hospital compare (HCAHPS) Data collected 7/1/2010-6/30/2011; U.S. Department of Health & Human Services

0.85

From Hospital…

Discharge planning begins on admission.

To home…

Transition home is health promotion.

Pulmonary Rehabilitation Treatment for Lung Disease

 Improve respiratory muscle function  Pulmonary Rehabilitation  LVRS – surgical removal of portion of lung(s)  Lung Transplant  Trial – Endobronchial valve for Emphysema

http://www.emphasysmedical.com/animation%2Dpopup%2D08/

Functional Ability Impaired

 Dyspnea  Deconditioned  Recurrent/Chronic Lung Infection  Activities of Daily Living/ Quality of Life Compromised

Appropriate Diagnoses

Obstructive Lung Disease with FEV1/FVC ≤ 69% of Predicted

Appropriate Diagnoses

Restrictive Lung Diseases (FEV1 or FVC ≤ 59% or DLCO ≤ 59% of Predicted)

Pulmonary Rehabilitation  Physician referral, PFT, Insurance Auth.

 12-24 Visits over 90 days  Initial Assessment, Pre-6 minute walk  Breathing training, Monitored exercise,  O2 provided to keep SpO2 ≥ 92% (Rx)  Exercise and Education at each session  Support for the caregiver/spouse/family

PeaceHealth Pulmonary Rehabilitation

Maikey Lopera, Exercise Physiologist with Patient in east gym at OHVI Springfield, OR SHMC RiverBend, OHVI Cardiovascular Wellness & Rehabilitation Florence, OR PeaceHarbor Hospital Cardiac & Pulmonary Rehabilitation Longview, WA St. John Medical Center Cardiac & Pulmonary Rehabilitation Vancouver, WA Southwest Medical Center Heart & Vascular Center

Supervised Exercise Program following Pulmonary Rehabilitation  Upon discharge & post 6 minute walk  Patients are encouraged to continue  Setting is familiar and spouse/family member is allowed to join  Gym available 5 days a week  Tai Chi (2-5 sessions/ week)  Chair Yoga (3 sessions/ week)

Ongoing exercise conditioning includes more than treadmill walking Left: Nu-Step, Seated recumbent stepper; Above: Suman Barkhas outside at World Tai Chi Day

BETTER BREATHERS CLUB

 Meet monthly to provide an outpatient support for people affected by lung disease.

 Second Wednesday at SHMC-RiverBend-OHVI  Third Tuesday at MWMC Willamalane Senior Center Annual pulmonary rehabilitation reunion and BB picnic held 2009 Island Park, Springfield

Thank you for the work you have done and are going to do!

 Make a difference in a patient’s life - allow them to share their story with you.  Help the next chronic lung disease patient you work with understand how to take better care of their breathing.

 Transform the knowledge of respiratory care modalities delivered in hospital to ways of delivering care outside that typical setting.

In Summary

 Role of RCP may be underestimated  As an RCP, you are an educator  Align yourself with physicians, nurses, other therapies to be a team player  Success in discharge planning may be directly linked to relationship you develop with team members

Thank You Norma & Kellee!

Respiratory Care Program at LCC wouldn’t be the same without you!