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COPD -Review of ‘At Risk Patient’ Mary Twitchett RGN MSc MSt (Cantab) Advanced Nurse Practitioner Dr Gant and Partners 114 Arbury Rd Cambridge [email protected] 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 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 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 Smokin g Breathlessness & exercise limitation Frequent exacerbatio ns Respirator y failure Palliative care Cor pulmonal e Abnor mal BMI Chronic producti ve cough Anxiety & depressi on “ 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 “ Practitioners challenges • • • • • • Build a relationship/ partnership Empathy Role with ambivalence Challenge Thoughts Goal set Follow up What are the questions? Reproduced from: COPD Assessment Test Healthcare Professional User Guide 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 [2004] palliative care People with end-stage COPD (and their families and carers)
