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Asthma Care Pathway and Specialist Respiratory Care

Asthma Care Pathway and Specialist Respiratory Care. Nicky, Lyndsay and Oriana 8 th February 2007. INTEGRATED CARE PATHWAY.

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Asthma Care Pathway and Specialist Respiratory Care

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  1. Asthma Care Pathway and Specialist Respiratory Care Nicky, Lyndsay and Oriana 8th February 2007

  2. INTEGRATED CARE PATHWAY • An integrated care pathway determines locally agreed, multidisciplinary practice. It is based on guidelines and evidence, and directed at a specific patient/client group. It forms all / part of the clinical record, documents the care given and facilitates the evaluation of outcomes for continuous quality improvement “ (National Pathways Association UK 2001, cited by Gordon 2004)

  3. CARE PATHWAY FOR ASTHMA • First chronic diseases to benefit from national guidelines • Standardised diagnosis and treatment of asthma • Enables communication and sharing of information between healthcare providers • Most common chronic disorders seen in primary and secondary care • Sharing information between health care providers is however poor and is the major addition provided by this pathway.

  4. CARE PATHWAY FOR ASTHMA • Locally developed • The British Guideline on the Management of Asthma :- British Thoracic Society & The Scottish Intercollegiate Guidelines (2004) ………….

  5. ASTHMA IN A & E

  6. ICP FOR ACUTE ASTHMA • A&E Admission • Medical unit Admission - CDU / MAU: • Ward Admission - Stage1: Recovery - Stage 2: Stabilization ~obs, medical review, nursing care, physiotherapy. - Stage 3: Discharge ~includes Asthma specialist nurse assessment. - Stage 4: Discharge day: ~medical review, nursing care, physio, MDT. ~Pt letter - re: follow up appt.

  7. EVIDENCE A study from Johns Hopkins: - multidisciplinary team combined to create the care pathway & a weaning protocol designed for asthma patients between two and 18 years of age. Results shows that with the ICP: - significantly shorter hospital stay - higher % discharged in the first day - less use of β-agonists. - lower cost

  8. ON THE WARD……. • Aim – to achieve control of underlying disease and symptom management • Reduce occurrence of asthma exacerbation • Minimise disruption to personal, social and professional life, thus optimising quality of life • Work with Simon to identify the trigger • Actively involve him in the management of his asthma

  9. NURSING INTERVENTION • Psychological support and reassurance of paramount importance • Administer medication as prescribed • MEWS – monitoring signs of deterioration • Using a peak flow meter and recognising significance of the readings • Teaching nebuliser and inhaler technique • Assist with ABGs • Co-ordinate with physiotherapist

  10. RESPIRATORY NURSE SPECIALISTskills required: • Empathy! • Systematic respiratory assessment • Assisting with bronchoscopy and thoracoscopy • Blood gas analysis • Allergy testing • Lung function tests • X-ray interpretation • NIV • Trachestomy care • Oxygen therapy • CVP monitoring • Management of chronic illness • Teaching self medication • Initiating management plans • Teaching equipment management and care • Support in hospital and home • Breaking bad news • Counselling • Continuing care

  11. PHYSIOTHERAPY • Based within the hospital • Patient referred to service • Physio will visit and assess • Works with patient to formulate plan of care • Communicates with nursing/medical staff, verbally and writing in medical notes • Nursing/medical staff can then reinforce techniques/exercises and encourage patient compliance

  12. AIM • The main aim of the physiotherapist working with an asthmatic patient is to ensure clear airways

  13. TECHNIQUES/EXERCISES • Comfortable positioning • Breathing retraining to promote deeper, slower breathing • Active cycle of breathing • Chest percussion • Coughing exercises/assisted coughing • Use of ancillary muscles

  14. TECHNIQUES/EXERCISES • Assist with nebuliser technique • Encourage relaxation of upper chest and shoulder muscles • Discuss general fitness

  15. REFERENCES • Alexander M, Fawcett J, Runciman P (2002) Nursing Practice Hospital & Home. The Adult. 2nd edn. Edinburgh:Elsevier Science Ltd • British Thoracic Society and SIGN (2004) The British guideline on the management of asthma: A national clinical guideline (online) www.brit-thoracic.org.uk • Carter, A (2005) Breath of fresh air. Nursing Standard 19 (32) • Cox, C (2002) Non-pharmacological treatment of breathlessness. Nursing Standard 16 (24) 33-36 • Dickinson A, Martindale G (2003) Caring for the patient with a respiratory disorder. In Watson’s Clinical Nursing and Related Sciences, ed. M Walsh p334-370 • Gordon, C (2004) Pathways protocol, guidelines, decision, support. Royal Brompton Hospital (online) http://www.ehealthnurses.org.uk

  16. REFERENCES • Harrison T, Mortimer K, Brett S (2006) Service implementation – do once and share: Asthma Action team Final Report. Version 3.0 NHS (online) http://www.informatics.nhs.uk • Hopkins, J (n.d) Treatment protocol effectiveness: inpatient asthma management. Bandolier (online) http://www.jr2.ox.ac.uk • Johnson, S ed (n.d) Pathways of care. Blackwell Science. Book isbn 0632040769 (online) available from http://books.google.com • Roberts J (2002) The management of poorly controlled asthma. Nursing Standard 16 (21) P45-51 • Scullion, J (2005) A proactive approach to asthma. Nursing Standard 20 (9)

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