Manaia PHORespiratory Support

Services

Presented by Sue ArmstrongPresented by Sue Armstrong

Manaia PHO Clinical Nurse Specialist/EducatorManaia PHO Clinical Nurse Specialist/Educator

BackgroundBackgroundAsthma Society & Manaia PHOAsthma Society & Manaia PHO

Respiratory Support ServicesRespiratory Support ServicesCNS / Educator roleCNS / Educator role

Aims of serviceAims of service•Up-skilling PHCN’sUp-skilling PHCN’s

•Improving links between secondaryImproving links between secondary & primary services& primary services

•Linking people back into general practices Linking people back into general practices

•Resource Nurse Resource Nurse •Clinic for more complex casesClinic for more complex cases & diagnostic spirometry – GP referrals& diagnostic spirometry – GP referrals

•Formation of Spirometry HubsFormation of Spirometry Hubs

•

Up-skilling PHC NursesUp-skilling PHC Nurses

Goal:

For all PHC Nurses in Northlandto be competent in assessing and managing

patients with respiratory conditions

Asthma/COPD Fundamentals Asthma/COPD Fundamentals CourseCourse

(12 hrs professional development)(12 hrs professional development)

A comprehensive resource manual is provided for each nurseA comprehensive resource manual is provided for each nurse

Respiratory CNS to support nurse back in Practice by being present Respiratory CNS to support nurse back in Practice by being present in 2 consultations; implementing assessment and management in 2 consultations; implementing assessment and management

skills taught on courseskills taught on course

Next course:Next course: 7 & 8th November7 & 8th November

Resource NurseResource NurseFor GP’s & PHC NursesFor GP’s & PHC Nurses

Asthma Patient EducationAsthma Patient EducationSStandardised / same info across secondary servicesSpacer techniqueEmergency Plan

Primary Health Care NursesPrimary Health Care NursesProgress to date: Progress to date:

√ 48 nurses have completed this course√ 48 nurses have completed this course

Secondary Care NursesSecondary Care Nurses

Asthma Patient EducationAsthma Patient EducationStandardised / same info across secondary servicesStandardised / same info across secondary services

Spacer techniqueSpacer techniqueEmergency PlanEmergency Plan

Progress to date:Progress to date:

√ NDHB Paediatric ward √ NDHB Paediatric ward√ Medical Outreach√ Medical Outreach

√ NDHB NETP nurses √ NDHB NETP nurses √ Public Health Nurses √ Public Health Nurses

√ Invited to teach at ED Nurses Study day √ Invited to teach at ED Nurses Study day

A proposal to NDHB for delivering Fundamentals trainingA proposal to NDHB for delivering Fundamentals training

Weekly ClinicsWeekly ClinicsGP referralsGP referrals

Diagnostic spirometry testingDiagnostic spirometry testingAsthma assessments & recommendations for managementAsthma assessments & recommendations for management

Complex COPD patientsComplex COPD patients

Progress to date:Progress to date: 72 patients seen in past 4 months 72 patients seen in past 4 months

More of these patients will be directed back into GP for assessment & More of these patients will be directed back into GP for assessment & managementmanagement

Encourage Encourage Nurse-led clinics Nurse-led clinics – latest research– latest researchNurses provide 80% of patients careNurses provide 80% of patients care

Spirometry HubsSpirometry HubsGoal:Goal:

To provide accessible , timely & accurate spirometry To provide accessible , timely & accurate spirometry to all patients requiring testing to all patients requiring testing

Progress to date:Progress to date:√ 3 PHC nurses completed course√ 3 PHC nurses completed course

(1 certified & 2 pending)(1 certified & 2 pending)√ Another 4 PHC nurses attending October training√ Another 4 PHC nurses attending October training

Spacer Technique for MDI’sSpacer Technique for MDI’s

• ShakeShake• Place in spacer end (making a good seal)Place in spacer end (making a good seal)• 1 puff & 6 normal breathes1 puff & 6 normal breathes• Wait 10 – 20 secs Wait 10 – 20 secs • RepeatRepeat

• ALL MDI’s to be usedALL MDI’s to be used with a spacer.with a spacer.• 80% more effective80% more effective

Emergency PlanEmergency Plan

Use reliever with spacerUse reliever with spacer (1 puff to 6 breaths )(1 puff to 6 breaths ) & repeat this 6 times& repeat this 6 times (The Asthma Foundation, 2012)(The Asthma Foundation, 2012)

Managing ExacerbationsManaging Exacerbationsof COPDof COPD

Lung function will Lung function will never return never return to what it was prior to to what it was prior to the exacerbationthe exacerbation

Blue Card Blue Card on Discharge from Hospitalon Discharge from Hospital

Back pocket Abx Back pocket Abx Prednisone 30mg 10/7Prednisone 30mg 10/7

Education on sx of exacerbationEducation on sx of exacerbationMore coughing, wheezing or breathlessness than usualMore coughing, wheezing or breathlessness than usual

Needing to use inhalers more than usualNeeding to use inhalers more than usualA fever or feeling tires and unwellA fever or feeling tires and unwell

Changes in the amount or colour of your sputum/phlegmChanges in the amount or colour of your sputum/phlegm

Check spacer techniqueCheck spacer techniqueHealthy Homes ReferralHealthy Homes Referral

Pulmonary rehab / self management course referralPulmonary rehab / self management course referralBooklet on ‘Managing COPDBooklet on ‘Managing COPD

Acknowledgement Acknowledgement of current PHC nursesof current PHC nursesbuilding on experiencebuilding on experience

supporting new graduatessupporting new graduates

working towards capacity, capability and working towards capacity, capability and confidence of PHC nurses in managing respiratory confidence of PHC nurses in managing respiratory

conditionsconditions