Manaia PHO Respiratory Support Services Presented by Sue Armstrong Presented by Sue Armstrong Manaia PHO Clinical Nurse Specialist/Educator Manaia PHO Clinical Nurse Specialist/Educator
Jan 02, 2016
Manaia PHORespiratory Support
Services
Presented by Sue ArmstrongPresented by Sue Armstrong
Manaia PHO Clinical Nurse Specialist/EducatorManaia PHO Clinical Nurse Specialist/Educator
BackgroundBackgroundAsthma Society & Manaia PHOAsthma Society & Manaia PHO
Respiratory Support ServicesRespiratory Support ServicesCNS / Educator roleCNS / Educator role
Aims of serviceAims of service•Up-skilling PHCN’sUp-skilling PHCN’s
•Improving links between secondaryImproving 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 casesClinic for more complex cases & diagnostic spirometry – GP referrals& diagnostic spirometry – GP referrals
•Formation of Spirometry HubsFormation of Spirometry Hubs
•
Up-skilling PHC NursesUp-skilling PHC Nurses
Goal:
For all PHC Nurses in Northlandto be competent in assessing and managing
patients with respiratory conditions
Asthma/COPD Fundamentals Asthma/COPD Fundamentals CourseCourse
(12 hrs professional development)(12 hrs professional development)
A comprehensive resource manual is provided for each nurseA comprehensive resource manual is provided for each nurse
Respiratory CNS to support nurse back in Practice by being present Respiratory CNS to support nurse back in Practice by being present in 2 consultations; implementing assessment and management in 2 consultations; implementing assessment and management
skills taught on courseskills taught on course
Next course:Next course: 7 & 8th November7 & 8th November
Resource NurseResource NurseFor GP’s & PHC NursesFor GP’s & PHC Nurses
Asthma Patient EducationAsthma Patient EducationSStandardised / same info across secondary servicesSpacer techniqueEmergency Plan
Primary Health Care NursesPrimary Health Care NursesProgress to date: Progress to date:
√ 48 nurses have completed this course√ 48 nurses have completed this course
Secondary Care NursesSecondary Care Nurses
Asthma Patient EducationAsthma Patient EducationStandardised / same info across secondary servicesStandardised / same info across secondary services
Spacer techniqueSpacer techniqueEmergency PlanEmergency Plan
Progress to date:Progress to date:
√ NDHB Paediatric ward √ NDHB Paediatric ward√ Medical Outreach√ Medical Outreach
√ NDHB NETP nurses √ NDHB NETP nurses √ Public Health Nurses √ Public Health Nurses
√ Invited to teach at ED Nurses Study day √ Invited to teach at ED Nurses Study day
A proposal to NDHB for delivering Fundamentals trainingA proposal to NDHB for delivering Fundamentals training
Weekly ClinicsWeekly ClinicsGP referralsGP referrals
Diagnostic spirometry testingDiagnostic spirometry testingAsthma assessments & recommendations for managementAsthma assessments & recommendations for management
Complex COPD patientsComplex COPD patients
Progress to date:Progress to date: 72 patients seen in past 4 months 72 patients seen in past 4 months
More of these patients will be directed back into GP for assessment & More of these patients will be directed back into GP for assessment & managementmanagement
Encourage Encourage Nurse-led clinics Nurse-led clinics – latest research– latest researchNurses provide 80% of patients careNurses provide 80% of patients care
Spirometry HubsSpirometry HubsGoal:Goal:
To provide accessible , timely & accurate spirometry To provide accessible , timely & accurate spirometry to all patients requiring testing to all patients requiring testing
Progress to date:Progress to date:√ 3 PHC nurses completed course√ 3 PHC nurses completed course
(1 certified & 2 pending)(1 certified & 2 pending)√ Another 4 PHC nurses attending October training√ Another 4 PHC nurses attending October training
Spacer Technique for MDI’sSpacer Technique for MDI’s
• ShakeShake• Place in spacer end (making a good seal)Place in spacer end (making a good seal)• 1 puff & 6 normal breathes1 puff & 6 normal breathes• Wait 10 – 20 secs Wait 10 – 20 secs • RepeatRepeat
• ALL MDI’s to be usedALL MDI’s to be used with a spacer.with a spacer.• 80% more effective80% more effective
Emergency PlanEmergency Plan
Use reliever with spacerUse 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)
Managing ExacerbationsManaging Exacerbationsof COPDof COPD
Lung function will Lung function will never return never return to what it was prior to to what it was prior to the exacerbationthe exacerbation
Blue Card Blue Card on Discharge from Hospitalon Discharge from Hospital
Back pocket Abx Back pocket Abx Prednisone 30mg 10/7Prednisone 30mg 10/7
Education on sx of exacerbationEducation on sx of exacerbationMore coughing, wheezing or breathlessness than usualMore coughing, wheezing or breathlessness than usual
Needing to use inhalers more than usualNeeding to use inhalers more than usualA fever or feeling tires and unwellA fever or feeling tires and unwell
Changes in the amount or colour of your sputum/phlegmChanges in the amount or colour of your sputum/phlegm
Check spacer techniqueCheck spacer techniqueHealthy Homes ReferralHealthy Homes Referral
Pulmonary rehab / self management course referralPulmonary rehab / self management course referralBooklet on ‘Managing COPDBooklet on ‘Managing COPD
Acknowledgement Acknowledgement of current PHC nursesof current PHC nursesbuilding on experiencebuilding on experience
supporting new graduatessupporting new graduates
working towards capacity, capability and working towards capacity, capability and confidence of PHC nurses in managing respiratory confidence of PHC nurses in managing respiratory
conditionsconditions