COPD -Review of ‘At Risk Patient’
Mary Twitchett RGN MSc MSt (Cantab)
Advanced Nurse Practitioner
Dr Gant and Partners
114 Arbury Rd
Cambridge
MaryTwitchett@nhs.net
COPD ‘At Risk’ Patients
Who Are They ?
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Hospital admission for COPD
> 2 Exacerbations per year
> 2 courses of steroids a year
Severe COPD
MRC score 4-5 ( ? 3)
CAT Score > 20
Mild COPD patient
COPD patient with low psychological profile
Housebound
Key Factors of Review
• COPD review : usual review of patient as done at annual review
• Assessment tools –MRC/ DOSE/ CAT score
• Smoking / Inhaler technique/ Pulmonary rehabilitation
Oxygen sats when well
• Self Management Plan
• Exacerbation Pack
• Advise out of hours
• DOCUMENTATION
Managing stable COPD
Patient with COPD
Assess symptoms/problems
Manage those that are present as below
Patients with COPD should have access to the wide range of
skills available from a multidisciplinary team
Smokin
g
Breathlessness
& exercise
limitation
Frequent
exacerbatio
ns
Respirator
y failure
Palliative care
Cor
pulmonal
e
Abnor
mal
BMI
Chronic
producti
ve
cough
Anxiety
&
depressi
on
“ Patient Myths”
• “My shortness of breath is just old age.”
• “There’s nothing my doctor can do except
tell
me to quit smoking.”
• “If I rest more, it will get better.”
• “It’s my own fault – I don’t want to bother them
“
Practitioners challenges
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Build a relationship/ partnership
Empathy
Role with ambivalence
Challenge Thoughts
Goal set
Follow up
What are the questions?
Reproduced from: COPD Assessment Test Healthcare Professional User Guide
Multidisciplinary working
– COPD care should be delivered by a multidisciplinary team that includes
respiratory nurse specialists
– Consider referral to specialist departments (not just respiratory
physicians)
Specialist
department
Who might benefit?
Physiotherapy
Advice about excessive sputum
Dietetic advice
People with BMI that is high, low
or changing over time
Occupational
therapy
People needing help with daily
living activities
Social services
People disabled by COPD
Multidisciplinary
[2004]
palliative care
People with end-stage COPD
(and their families and carers)