1. Manaia PHO Respiratory Support Services Presented by Sue Armstrong Manaia PHO Clinical Nurse Specialist/Educator Manaia PHO Clinical Nurse Specialist/Educator

2. Background Asthma Society & Manaia PHO

3. Respiratory Support Services CNS / Educator role Aims of service Up-skilling PHCN’s Up-skilling PHCN’s Improving links between secondary Improving links between secondary & primary services & primary services Linking people back into general practices Linking people back into general practices Resource Nurse Resource Nurse Clinic for more complex cases Clinic for more complex cases & diagnostic spirometry – GP referrals & diagnostic spirometry – GP referrals Formation of Spirometry Hubs Formation of Spirometry Hubs

4. Up-skilling PHC Nurses Up-skilling PHC Nurses Goal: For all PHC Nurses in Northland to be competent in assessing and managing patients with respiratory conditions

5. Asthma/COPD Fundamentals Course (12 hrs professional development) A comprehensive resource manual is provided for each nurse Respiratory CNS to support nurse back in Practice by being present in 2 consultations; implementing assessment and management skills taught on course Next course: 7 & 8th November

6. Resource Nurse For GP’s & PHC Nurses Asthma Patient Education S Primary Health Care Nurses Progress to date: √ 48 nurses have completed this course Resource Nurse For GP’s & PHC Nurses Asthma Patient Education S tandardised / same info across secondary services Spacer technique Emergency Plan Primary Health Care Nurses Progress to date: √ 48 nurses have completed this course

7. Secondary Care Nurses Asthma Patient Education Standardised / same info across secondary services Spacer technique Emergency Plan Progress to date: √ NDHB Paediatric ward √ Medical Outreach √ NDHB NETP nurses √ Public Health Nurses √ Invited to teach at ED Nurses Study day A proposal to NDHB for delivering Fundamentals training

8. Weekly Clinics GP referrals Diagnostic spirometry testing Asthma assessments & recommendations for management Complex COPD patients Progress to date: 72 patients seen in past 4 months More of these patients will be directed back into GP for assessment & management Encourage Nurse-led clinics – latest research Nurses provide 80% of patients care

9. Spirometry Hubs Goal: To provide accessible, timely & accurate spirometry to all patients requiring testing Progress to date: √ 3 PHC nurses completed course (1 certified & 2 pending) √ Another 4 PHC nurses attending October training Spirometry Hubs Goal: To provide accessible, timely & accurate spirometry to all patients requiring testing Progress to date: √ 3 PHC nurses completed course (1 certified & 2 pending) √ Another 4 PHC nurses attending October training

10. Spacer Technique for MDI’s Shake Shake Place in spacer end (making a good seal) Place in spacer end (making a good seal) 1 puff & 6 normal breathes 1 puff & 6 normal breathes Wait 10 – 20 secs Wait 10 – 20 secs Repeat Repeat ALL MDI’s to be used ALL MDI’s to be used with a spacer. with a spacer. 80% more effective 80% more effective

11. Emergency Plan Use reliever with spacer Use reliever with spacer (1 puff to 6 breaths ) (1 puff to 6 breaths ) & repeat this 6 times & repeat this 6 times (The Asthma Foundation, 2012) (The Asthma Foundation, 2012)

12. Managing Exacerbations of COPD Lung function will never return to what it was prior to the exacerbation

13. Blue Card on Discharge from Hospital Back pocket Abx Prednisone 30mg 10/7 Education on sx of exacerbation More coughing, wheezing or breathlessness than usual Needing to use inhalers more than usual A fever or feeling tires and unwell Changes in the amount or colour of your sputum/phlegm Check spacer technique Healthy Homes Referral Pulmonary rehab / self management course referral Booklet on ‘Managing COPD

14. Acknowledgement of current PHC nurses building on experience supporting new graduates working towards capacity, capability and confidence of PHC nurses in managing respiratory conditions