Download Role of In-Home Services in COPD Management and Reducing Hospitalizations and more Lecture notes Nursing in PDF only on Docsity!
IN-HOME QUALITY IMPROVEMENT
BEST PRACTICE:
DISEASE MANAGEMENT
Chronic Obstructive Pulmonary Disease
NURSE TRACK
Best Practice Intervention Packages were designed for use by any In-Home Provider Agency to support reducing avoidable hospitalizations and emergency room visits. Any In-Home care nurse/clinician can use these educational materials.
Best Practice Intervention Packages were designed to educate and create awareness of strategies and interventions to reduce avoidable hospitalizations and unnecessary emergency room visits.
Nurse Track
This best practice intervention package track is designed to educate nurses in disease management and to provide an update on symptom management of high-risk diagnosis.
Objectives
After completing the activities included in the Nurse Track of this Best Practice Intervention Package, Disease Management , the learner will be able to:
- Identify the role of In-Home Services in disease management and reducing avoidable acute care hospitalizations
- Apply current assessment and symptom management modalities in daily practice
- Describe two nursing actions that support an effective disease management program
Complete the following activities:
- Read Disease Management and In-Home Services.
- Read “Polish Your Practice: COPD”.
- Review the Decision Support Tool: COPD.
- Complete the Nursing Post Test.
Disclaimer: Some of the information contained within this Best Practice Intervention Package may be more directed and intended for an acute care setting, or a higher level of care or skilled level of care setting such as those involved in Medicare. The practices, interventions and information contained are valuable resources to assist you in your knowledge and learning.
Disclaimer: All forms included are optional forms; each can be used as Tools, Templates or Guides for your agency and as you choose. Your individual agency can design or draft these forms to be specific to your own agency’s needs and setting.
Chronic Obstructive Pulmonary Disease (COPD) is presented as the primary resource for this Disease Management package. You or your agency management may want to elect to pursue Heart Failure as an associated package.
Polish Your Practice:
COPD
This material was prepared by Quality Insights of Pennsylvania, the Medicare Quality Improvement Organizations Support Center for Home Health, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy.
Definition
Chronic obstructive pulmonary disease (COPD) is characterized by the progressive development of airflow limitation that is not reversible and it encompasses chronic obstructive bronchitis, emphysema and mucus plugging. Most patients with COPD have all three conditions. COPD affects 14-20 million Americans each year.
Pathophysiology
COPD is a disease state characterized by airflow limitation that is not fully reversible. The airflow limitation is usually both progressive and associates with an abnormal inflammatory response of the lungs to noxious particles or gases. It is likely that there are interactions between environmental factors and a genetic predisposition to COPD, which makes some people more prone to develop COPD than others.
There is a chronic inflammatory process in COPD that differs from that seen with asthma. Over time, those with COPD not only develop a chronic cough, but experience changes in lung capacity, purulent sputum and a decline in pulmonary function. Many develop weight loss and fatigue since they can’t eat or sleep due to the dyspnea and possible respiratory distress.
The most important risk factor for COPD is cigarette smoking. A diagnosis of COPD should be considered in any individual with symptoms and a history of exposure to risk factors. The diagnosis should be confirmed by spirometry.
Symptoms (Acute worsening of these symptoms occurs during exacerbations)
Dyspnea
- Patient’s subjective awareness of altered or uncomfortable breathing
- Most common symptom characterizing pulmonary pathophysiology May assess using the modified Borg perceived level of dyspnea scale Cough
- Can be debilitating associated with sleeplessness, fatigue and chest pain Sputum production Respiratory distress
- Physical or emotional suffering that results from the experience of dyspnea can be observed and measured objectively in the absence of a patient self-report Sleeplessness
Symptom exacerbations are often associated with COPD. They may be caused by pulmonary infections or an increase in air pollution, but the cause of about 30 percent of severe exacerbations can’t be identified. If the patient’s risk for respiratory acidosis has been determined and stabilized, patients can typically be managed at home with success.
Determine disease severity for an individual with consideration of patient’s symptoms, complications, general respiratory status, co-morbidities and general health status.
Polish Your Practice: COPD
(Polish Your Practice: COPD)
Treatment of COPD
The quality of life for a person suffering from COPD diminishes as the disease progresses. None of the existing medications for COPD has been shown to improve the long-term decline in lung function, therefore the goal of treatment is to provide relief of symptoms and prevent complications and/or progression of the disease with minimal side effects.
Pharmacological
Primary treatment for COPD is pharmacological, using a combination of bronchodilators, both short-acting and long-acting, systemic corticosteroids and antibiotics as needed for exacerbations of bronchitis or pneumonia.
Immunization
Further treatment includes ensuring patients receive flu and pneumonia vaccines if they have no allergies or contraindications.
Oxygen
Oxygen therapy may eventually be needed to help ensure adequate supply to the tissues of the body to prevent stimulation of the sympathetic nervous system and renal cascade that can lead to the development of heart failure and increase oxygen demand.
Pulmonary Rehabilitation
Pulmonary Rehabilitation consisting of exercise training is beneficial to help patients prevent further deterioration of lung function, and help patient cope physically, psychologically and socially with COPD.
AAT Replacement Therapy
For patients with Alpha-1 Antitrypsin Deficiency related emphysema, treatment includes life-long AAT replacement therapy.
Smoking Cessation
Smoking cessation classes, medications and alternative methods can assist patients to stop smoking.
(Polish Your Practice: COPD)
Exacerbation Indicators for Possible Hospitalization
Marked increase in symptom intensity, such as sudden development of resting dyspnea
Newly occurring dysrhythmias
Onset of new physical signs such as cyanosis and peripheral edema
Insufficient home support
Failure of exacerbation to respond to initial medical management
Instruct patient on keeping a written log of weights and taking it to every doctor visit Malnutrition, exhaustion, depression or sleep deprivation
Inability to manage self in absence of caregiver
Self-Management
Self-Management Self-Management Support
SMOKING CESSATION!!! (^) • Assist patient in obtaining assistance with smoking cessation if indicated Participate in a home exercise program that helps strengthen muscles, increase lung elasticity and includes energy conservation techniques.
- Consult physical and/or occupational therapy to help patient develop a home exercise program
- Teach patient effective breathing techniques, such as pursed lip breathing or disphragmatic breathing
- Teach patient pacing strategies for activities to assist with energy conservation Eat small, frequent, high protein meals that are easy to chew. Drink plenty of fluids to thin secretions and aid in their elimination.
- Assist patient with meal planning; many COPD patients are protein malnourished as nutrition is poor
- Help patients choose foods that have high protein content to help prevent muscle breakdown Take all medications as prescribed. (^) • Instruct patient on actions, benefits and side effects of medications; greater understanding of the reason for taking medications increases compliance
- Observe patient’s ability to use inhalant medications to obtain full benefit from inhalant
- Many long-acting bronchodilators and inhaled steroids will yield no benefit if not taken regularly and allowed to build-up to a therapeutic level in the body Weigh daily at the same time each morning, wearing the same amount of clothing, after emptying bladder and before eating or drinking.
- Instruct patient on proper technique for daily weights; instruct patient on importance of obtaining a scale if he/she does not already own one
- Instruct patient to report a weight gain of 2-3 lbs. in 24 hours or 5 lbs. in one week
(Polish Your Practice: COPD)
Decision Support Tool: COPD
No
No
No
No
Yes
Yes
Is dyspnea very severe and/or Patient reports increased level of sudden onset? dyspnea and/or other signs of potential COPD exacerbation (e.g., Sa , 90%, increased cough, sputum, decreased energy or appetite)
Does patient have significant co- morbidities or any of the following signs/symptoms: cyanosis, new peripheral edema, restlessness, sleepiness, nausea, vomiting?
Activate 911 or notify MD as appropriate; anticipate emergent care/ hospitalization
Yes
No
Yes
This material was developed by OASIS Answers, Inc. and distributed by Quality Insights of Pennsylvania, the Medicare Quality Improvement Organization Support Center for Home Health under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services.
Is the home environment safe and is there an available caregiver in the home?
No
Notify MD of signs/symptoms. Anticipate/recommend home treatment for exacerbation. Anticipate orders such as: increase dosage/frequency of bronchodilator oral corticosteroids antibiotics if purulent sputum
Yes Are orders to treat at home obtained?
Instruct patient in new orders (telephone call or home visit)
Ensure MD appointment within 1 day
Telephone follow-up call to assess patient condition and/or response to treatment within 8- hours
Are the patient’s symptoms stabilizing or improving?
Home visit to assess patient response within 24-36 hours
Are the patient’s symptoms stabilizing or improving?
Continue with home care plan for COPD management Reinforce patient education regarding decreasing risk of future exacerbations (e.g., decreasing risk of infection, avoiding exposure to lung irritants) Review proper use and administration of prescribed medications including inhaled medications
Yes
