1. COPD and Outreach Services Mandy Dickson Clinical Nurse Specialist Respiratory Outreach Service

2. What’s New? Clinical Strategy for COPD

3. My Role Provide education and share knowledge to staff, patients and carers Act as a resource for other healthcare professionals Run nurse-led clinic for chronic disease Respiratory Outreach Service manager

4. Respiratory Outreach Service The Respiratory Outreach Service was set up in 2002 to facilitate the early supported discharge of respiratory patients, mainly those with COPD. The aim of the service was to discharge patients within 3 days of admission and continue their treatment at home.

5. How do we find our patients? Admissions List Referral from ANY team A&E or Obs ward Outpatients Clinic

6. Criteria Oxygen saturations >90% on air or LTOT PH within normal limits No acidosis CXR – minimal consolidation, no pneumothorax or pulmonary oedema No worsening peripheral oedema No acute confusion No nocturnal dyspnoea

7. Able to transfer safely/independently Self caring or home support available Self medicating or support available Access to telephone Patient agreement

8. Our Role in Discharge Respiratory assessment Measure against the criteria for early supported discharge. Inform medical team patient meets our criteria for discharge TTA’s Transport

9. Patients would need to meet a strict criteria to ensure their safety Discharged home on nebulizers, steroids and +/- antibiotics Loan of equipment Daily visits from specialist trained nurses to provide full respiratory assessment, monitoring of condition, treatment changes, and education

10. Although patients are discharged from the hospital they remain under the care of the Outreach Service and the Respiratory Team have medical responsibility until we discharge them. Follow-up, if required, is with the discharging team or Respiratory Nurse Clinic.

11. Benefits of the Service Length of stay in hospital down from 13.9 to <2.9 days Readmission rate <3%, and usually for respiratory unrelated reason Better education and development of self management skills to prevent admissions in the future

12. Breathlessness Clinic The Breathlessness Clinic is a non- pharmacological intervention to help patients with breathlessness linked to moderate to severe COPD improve ways of coping with their condition and improve their quality of life.

13. People involved Clinical Health Psychologist Respiratory Nurse Physiotherapist Occupational Therapist

14. Criteria Moderate /Severe COPD Suffering from breathlessness and/or panic attacks Breathlessness of a chronic nature Finding it hard to cope No unstable cardiac conditions Able to understand English Suitable for group setting and would benefit from self-management techniques Would like to attend the Breathlessness Clinic

15. Course Content Five week group clinic Coping with anxiety and panic attacks Education on lung disease/medication Breathing control techniques Planning and pacing activities Relaxation/distraction techniques Carers/partners encouraged to attend

16. Referral Referrals should be directed to the Clinical Health Psychology Department