COPD -Review of ‘At Risk Patient’

1. COPD -Review of ‘At Risk Patient’ Mary Twitchett RGN MSc MSt (Cantab) Advanced Nurse Practitioner Dr Gant and Partners 114 Arbury Rd Cambridge MaryTwitchett@nhs.net

2. COPD ‘At Risk’ PatientsWho 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

3. 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

4. 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 Palliative care

5. “ 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 “

6. Practitioners challenges • Build a relationship/ partnership • Empathy • Role with ambivalence • Challenge Thoughts • Goal set • Follow up

7. What are the questions? Reproduced from: COPD Assessment Test Healthcare Professional User Guide

8. Multidisciplinary working [2004] • COPD care should be delivered by a multidisciplinary team that includes respiratory nurse specialists • Consider referral to specialist departments (not just respiratory physicians)