1. Nottingham City Care Integrated Respiratory Service and Home Oxygen Service
Zoe Styles
Senior Physiotherapist

2. Integrated Respiratory Service

3. Team structure
Team of staff including Nurses, Physiotherapists, Community Support workers and Administrators.
Assess and manage respiratory patients (with confirmed respiratory diagnosis) who have a GP in the Nottingham City area.
Not all team members are full time

4. Contact details
Patients should all have a pink card and can contact us between 0800 and 1900
Contact number

5. Elements of Service Acute nursing visits
Post hospital discharge visits
Case Management
Nursing clinics
Pulmonary Rehabilitation
Acute Physiotherapy
Domiciliary Physiotherapy

6. Acute nursing visits
Patients contact the service using their pink card
Patients speak to a triage nurse to assess and establish if a visit is needed
Patients seen in their own home within 4 hours
Nurses complete a holistic assessment including respiratory assessment and guide on treatment as appropriate

7. Acute visits continued
Short term nebuliser loan
Working in partnership with other agencies (e.g. GP practice team, social services)
Access to respiratory assessment unit.
Follow up as indicated by clinical need.

8. Post Hospital Discharge Visits
Referrals from NUH for all respiratory patients on discharge
Telephone call to arrange an visit and discuss wellbeing
Holistic assessment
Referral to other aspects of the service as required (e.g. Pulmonary Rehabilitation)

9. Case management
Visits in patients own home, regular visits as required
Aim to prevent hospital admissions
Education and advice
Medicines review
Referral in to other aspects of the service as appropriate

10. Nursing clinics
Patients seen in clinics across the city (Bulwell riverside, Grange Farm, St Anns Valley Centre, Clifton Cornerstone)
Clinics to assess suitability for Pulmonary Rehabilitation
Respiratory review of patients able to attend clinic
Spirometry (for patients with complex needs or struggled with previous attempts)

11. Pulmonary Rehabilitation
Classes run at Beechdale Community Centre, Bulwell Riverside, Clifton Cornerstone and St Anns Valley Centre
Assessments run at each venue weekly
Rolling Programme
Post exacerbation

12. Pulmonary Rehabilitation continued
Sessions consist of exercise and education sessions
Each session is lead by a physiotherapist who will prescribe exercise based on a detailed assessment.
Education sessions include, benefits of exercise, What is happening in my lungs?, breathing control, chest clearance, medicines, inhaler technique, anxiety management, nutrition, energy conservation, dangers of smoking, community services, British lung foundation, managing exacerbations.

13. Acute physiotherapy
Patients in exacerbation referred when struggling to clear their chests
Holistic assessment including respiratory assessment
Chest clearance and breathlessness management.
Follow up arranged as appropriate

14. Domiciliary Physiotherapy
Home exercise programmes
Chest clearance
Breathlessness management

15. Home Oxygen Service
ASSESSMENT AND REVIEW

16. What we do: Assess patients for LTOT & Ambulatory
Review patients with oxygen
Blood gases
Oxygen removal
All oxygen assessments completed in the patients own home

17. Referral Criteria Oxygen saturations consistently below 92%
Significant desaturation on exertion
8 weeks clear of antibiotics / exacerbation
Not smoking
Already has oxygen

18. Oxygen Facts Oxygen is not used to treat breathlessness or anxiety
Blood gases need to be performed prior to prescription of oxygen
Oxygen should not be prescribed if patient is smoking
It is a medication
Can be harmful/fatal if used incorrectly or unnecessarily

19. Oxygen Facts continued
Patients must be on optimal medication
Referral to the service is for oxygen assessment and oxygen may not be indicated. This will be discussed during the assessment process
Oxygen can be delivered via nasal cannula or mask
Oxygen safety is discussed with all patients (e.g. it must not be used near naked flame including gas cooker, trailing oxygen tubing)

20. Patients not on oxygen Seen to assess need at very first visit
Blood gases in clinic for baseline and assessment of clinical indication
If blood gases indicate oxygen: titrate for LTOT
If blood gases do not indicate oxygen: assess for ambulatory
Oxygen saturations must be consistently below 92% to merit assessment

21. LTOT Patients Patients reviewed 12 monthly at home
Blood gases and home review completed
Oxygen needs change – patients on oxygen may not need it forever and it may be removed
Therapy is for minimum of 16 hours through a concentrator

22. Blood Gases Small sample of blood from patient’s ear lobe
Analysed there and then
To assess need for oxygen 2 baseline readings must be obtained
Patients must be stable and 8 weeks clear of antibiotics and steroids
Maintenance antibiotics or steroids are ok

23. Ambulatory assessments
Rehab setting only
Patients must have blood gas prior to assessment
For moderate to high level activity patients
Assessed by walking tests
Patients can have ambulatory without LTOT but this must be indicated by the tests

24. Palliative patients Still need a blood gas before prescribing
Must have hypoxic need not just breathless
Encourage fan therapy/breathing control/inhalers for breathlessness

25. Short Burst No clinical benefit therefore should not be prescribed
No longer fits with national guidelines

26. Removal When there is no clinical indication e.g. blood gases
If a patient is still smoking
Education on alternatives for breathlessness e.g. fan therapy
Follow up of oxygen saturations or blood gases 4 months later
Education on risks of using oxygen without clinical need