How can COPD Community Services reduce hospital admissions?

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How can COPD Community Services reduce hospital
admissions?

• Glenda Esmond
• Respiratory Nurse Consultant
• West Herts Community COPD Service

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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

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Effect of COPD Exacerbations
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How to Reduce Admissions

• Preventative care
• Early Management of exacerbation
• Recognition of palliative care needs

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Preventative Care

• Flu pneumococcal vaccination
• Smoking cessation
• Advice on exercise
• Advice on nutrition
• Self-management plan rescue pack
• Assess for anxiety and depression

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Pulmonary Rehabilitation
EXERCISE EDUCATION EXERCISE or
MAINTENANCE 2 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

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Hospital at Home (Early recognition Effective
support)
Consultant Led MDT Telephone advice
HOSPITAL at HOME
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Hospital at Home Outcomes
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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
• gt 6 weeks use of systemic steroids in
  the proceeding year or unable to reduce

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Quality v Quantity

• Do everything to keep me alive
• Do everything to keep me comfortable.

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Community COPD Pathway
PULMONARY REHAB
HOME OXYGEN
HOSPITAL AT HOME
COMMUNITY CLINICS
PULMONARY REHAB ASSESSMENTS
HOME OXYGEN ASSESSMENTS
ADMISSION AVOIDANCE
CONSULTANT RESPIRATORY PHYSICIAN CLINICS
EARLY SUPPORTED DISCHARGE
NURSE / AHP CLINICS Including home visits
HOSPITAL AT HOME
PULMONARY REHAB PROGRAMME
HOME OXYGEN FOLLOW-UP
SELF MANAGEMENT
REHAB Home Exercise
PULMONARY REHAB MAINTENANCE
PALLIATIVE CARE
SOCIAL SERVICES