How can COPD Community Services reduce hospital admissions?

Glenda EsmondRespiratory Nurse Consultant

West Herts Community COPD Service

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

Effect of COPD Exacerbations

Increased symptoms (breathlessness)

Increased risk of hospitalization

Respiratory Failure(GSF prognostic marker)

Decline in lung function

Worsening health status

How to Reduce Admissions

Preventative careEarly Management of exacerbation Recognition of palliative care needs

Preventative Care

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 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

Hospital at Home(Early recognition & Effective support)

Consultant LedMDT &

Telephone advice

HOSPITAL at

HOME

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

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

Quality v Quantity

“Do everything to keep me alive”“Do everything to keep me comfortable.”

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