West Essex Frailty Pathway: COPD Acute exacerbation of COPD Are signs of life threatening exacerbation present? Use Early Warning Score (NEWS) to guide judgement YES EWS ≥ 5 /- or known type 2 respiratory failure NO EWS 1-4 Maximise therapy and increase bronchodilator therapy via spacer. Commence antibiotics and steroids if increased sputum purulence and persistent wheeze Admit to hospital (if this is not an expected terminal event in a patient on an end of life care pathway) 1st line amoxicillin 500mg tds for 7 days or clarithromycin 500 mg bd if penicillin allergic 2nd line doxycycline 200mg stat then 100mg od for 7 days PLUS Prednisiolone 30mg od for 7-14 days Ongoing review – response to treatment Contact respiratory nurse specialist for urgent assessment if ongoing symptoms Failure to improve or evidence of mild deterioration/mild delirium/reducing mobility or inability to complete oral therapy or resistant bacteria is only responsive to IV medication OR social factors complicating management at home Contact SPA to consider urgent assessment in RAC for further investigations (CXR, sputum, MC&S) OR arrange direct admission to community bed for assessment treatment and rehabilitation Complete therapy for exacerbation. Consider follow up in primary care or by community matron for adherence to therapy/chronic disease follow up Community respiratory nurses can: Review and optimise inhaled therapy plus monitor compliance and inhaler technique Provide exacerbation management plans and rescue meds (antibiotics and steroids) Provide disease education to assist self care Treat and monitor exacerbations in community Provide pulmonary rehabilitation for patients with chronic poor symptom control Signpost for end of life care planning when signs of end stage terminal disease is evident Disease monitoring using Telehealth Blood gas monitoring and assessment for Long Term Oxygen Therapy (LTOT) SPA contact Monday to Friday 8am – 5pm for arranging admission – 01279 827524 Single Point of Access (SPA) 08:00-21:00, Seven days a week Telephone: 01279 827524 Fax: 01279 827827 Email: sep-tr.SinglePointOfAccess@nhs.net