how can copd community services reduce hospital admissions? glenda esmond respiratory nurse...
TRANSCRIPT
![Page 1: How can COPD Community Services reduce hospital admissions? Glenda Esmond Respiratory Nurse Consultant West Herts Community COPD Service](https://reader035.vdocument.in/reader035/viewer/2022062423/56649ea15503460f94ba4d8d/html5/thumbnails/1.jpg)
How can COPD Community Services reduce hospital admissions?
Glenda EsmondRespiratory Nurse Consultant
West Herts Community COPD Service
![Page 2: How can COPD Community Services reduce hospital admissions? Glenda Esmond Respiratory Nurse Consultant West Herts Community COPD Service](https://reader035.vdocument.in/reader035/viewer/2022062423/56649ea15503460f94ba4d8d/html5/thumbnails/2.jpg)
![Page 3: How can COPD Community Services reduce hospital admissions? Glenda Esmond Respiratory Nurse Consultant West Herts Community COPD Service](https://reader035.vdocument.in/reader035/viewer/2022062423/56649ea15503460f94ba4d8d/html5/thumbnails/3.jpg)
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
![Page 4: How can COPD Community Services reduce hospital admissions? Glenda Esmond Respiratory Nurse Consultant West Herts Community COPD Service](https://reader035.vdocument.in/reader035/viewer/2022062423/56649ea15503460f94ba4d8d/html5/thumbnails/4.jpg)
Effect of COPD Exacerbations
Increased symptoms (breathlessness)
Increased risk of hospitalization
Respiratory Failure(GSF prognostic marker)
Decline in lung function
Worsening health status
![Page 5: How can COPD Community Services reduce hospital admissions? Glenda Esmond Respiratory Nurse Consultant West Herts Community COPD Service](https://reader035.vdocument.in/reader035/viewer/2022062423/56649ea15503460f94ba4d8d/html5/thumbnails/5.jpg)
How to Reduce Admissions
Preventative careEarly Management of exacerbation Recognition of palliative care needs
![Page 6: How can COPD Community Services reduce hospital admissions? Glenda Esmond Respiratory Nurse Consultant West Herts Community COPD Service](https://reader035.vdocument.in/reader035/viewer/2022062423/56649ea15503460f94ba4d8d/html5/thumbnails/6.jpg)
Preventative Care
Flu & pneumococcal vaccination Smoking cessation Advice on exercise Advice on nutrition Self-management plan + rescue pack Assess for anxiety and depression
![Page 7: How can COPD Community Services reduce hospital admissions? Glenda Esmond Respiratory Nurse Consultant West Herts Community COPD Service](https://reader035.vdocument.in/reader035/viewer/2022062423/56649ea15503460f94ba4d8d/html5/thumbnails/7.jpg)
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
![Page 8: How can COPD Community Services reduce hospital admissions? Glenda Esmond Respiratory Nurse Consultant West Herts Community COPD Service](https://reader035.vdocument.in/reader035/viewer/2022062423/56649ea15503460f94ba4d8d/html5/thumbnails/8.jpg)
![Page 9: How can COPD Community Services reduce hospital admissions? Glenda Esmond Respiratory Nurse Consultant West Herts Community COPD Service](https://reader035.vdocument.in/reader035/viewer/2022062423/56649ea15503460f94ba4d8d/html5/thumbnails/9.jpg)
![Page 10: How can COPD Community Services reduce hospital admissions? Glenda Esmond Respiratory Nurse Consultant West Herts Community COPD Service](https://reader035.vdocument.in/reader035/viewer/2022062423/56649ea15503460f94ba4d8d/html5/thumbnails/10.jpg)
Hospital at Home(Early recognition & Effective support)
Consultant LedMDT &
Telephone advice
HOSPITAL at
HOME
![Page 11: How can COPD Community Services reduce hospital admissions? Glenda Esmond Respiratory Nurse Consultant West Herts Community COPD Service](https://reader035.vdocument.in/reader035/viewer/2022062423/56649ea15503460f94ba4d8d/html5/thumbnails/11.jpg)
![Page 12: How can COPD Community Services reduce hospital admissions? Glenda Esmond Respiratory Nurse Consultant West Herts Community COPD Service](https://reader035.vdocument.in/reader035/viewer/2022062423/56649ea15503460f94ba4d8d/html5/thumbnails/12.jpg)
![Page 13: How can COPD Community Services reduce hospital admissions? Glenda Esmond Respiratory Nurse Consultant West Herts Community COPD Service](https://reader035.vdocument.in/reader035/viewer/2022062423/56649ea15503460f94ba4d8d/html5/thumbnails/13.jpg)
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
![Page 14: How can COPD Community Services reduce hospital admissions? Glenda Esmond Respiratory Nurse Consultant West Herts Community COPD Service](https://reader035.vdocument.in/reader035/viewer/2022062423/56649ea15503460f94ba4d8d/html5/thumbnails/14.jpg)
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
![Page 15: How can COPD Community Services reduce hospital admissions? Glenda Esmond Respiratory Nurse Consultant West Herts Community COPD Service](https://reader035.vdocument.in/reader035/viewer/2022062423/56649ea15503460f94ba4d8d/html5/thumbnails/15.jpg)
Quality v Quantity
“Do everything to keep me alive”“Do everything to keep me comfortable.”
![Page 16: How can COPD Community Services reduce hospital admissions? Glenda Esmond Respiratory Nurse Consultant West Herts Community COPD Service](https://reader035.vdocument.in/reader035/viewer/2022062423/56649ea15503460f94ba4d8d/html5/thumbnails/16.jpg)
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