1. How can COPD Community Services reduce hospital admissions? Glenda Esmond Respiratory Nurse Consultant West Herts Community COPD Service

3. 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

4. Effect of COPD Exacerbations Increased symptoms (breathlessness) Increased risk of hospitalization Respiratory Failure (GSF prognostic marker) Decline in lung function Worsening health status

5. How to Reduce Admissions Preventative care Early Management of exacerbation Recognition of palliative care needs

6. Preventative Care Flu & pneumococcal vaccination Smoking cessation Advice on exercise Advice on nutrition Self-management plan + rescue pack Assess for anxiety and depression

7. 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

10. Hospital at Home (Early recognition & Effective support) Consultant Led MDT & Telephone advice HOSPITAL at HOME

13. Hospital at Home Outcomes

14. 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 > 6 weeks use of systemic steroids in the proceeding year or unable to reduce

15. Quality v Quantity “Do everything to keep me alive” “Do everything to keep me comfortable.”

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