Authors (including presenting author) :
TAI CE, SIN KM, CHAN KF, EMILY LEUNG
Introduction :
Chronic Obstructive Pulmonary Disease (COPD), now the fourth leading cause of death in the world, continues to increase in the developing countries. The World Health Organization (WHO) expects COPD to be the third most common cause of death in the world by 2020. Patients in advanced stage of COPD or other chronic lung diseases mostly have recurring respiratory decompensation and serious breathlessness. They need regular hospitalization to take care of the diseases.
Integrated COPD nurse clinic empowerment for COPD patient refers to a process involving both health care providers and patient in helping and motivating COPD patients to change and possess specific competencies using resources which promote or foster a sense of control and self-efficacy related to psychological functioning in self-management with chronic disease.
Objectives :
1. Assess and monitor disease severity
2. Educate on knowledge of their own disease: reduce risk factor and treatment
3. Enhance smoking cessation referral
Methodology :
Integrated COPD nurse clinic has been commenced in Oct 2019. After attended integrated COPD nurse clinic, respiratory nurse assessed patient and carer on the knowledge of the disease. Education was provided with educational booklet and action plan. Teach patient about the importance of identifying signs and symptoms and responding according to the individualized action plan that has been prescribed such as adjusting medications, adding steroids and/or antibiotics. Besides, patients were educated on self-management skills, home oxygen therapy and home non-invasive ventilation in which enhances patient’s knowledge of the disease.
Proper aerosol technique is critical to achieve effect of the therapy; aerosol technique should be serially monitored to assure adequate medication delivery. We used Test of Adherence to Inhaler (TAI) for inhalers assessment tool.
We also use COPD Assessment Test (CAT) tool that provides a simple and reliable measure of the overall COPD-related health status, and allows for a continuous and objective assessment during the long-term follow-up of individual patients
In order to assess the effectiveness of the integrated COPD nurse clinic, healthcare shall check number of admission for pre 90days & post 90days after attended integrated nurse clinic.
Result & Outcome :
Totally 174 patients had attended the clinic during 4th October 2019 to 30th November 2019 inclusively.
1. To reduce spirometry test the waiting time from 72 weeks to 4 weeks.
Spirometry test is to be done in the 1st integrated nurse clinic visit for baseline and or annually.
2. 75% patient were educated on rescue pack
3. 19% patients were referred to smoking cessation
4. 32% patients were received vaccination after referral
5. 27% medium impact of CAT score
6. Test of adherence to inhalers (TAI) analysis results as follow:
- 91% patients were poor inhaler technique
- 33% patients were wrong dose and frequency of inhalers
- 26% patients were poor adherence inhalers
- 17% patients forgot to use inhalers
- 16% patients were unwilling using inhalers
Understanding and using a plan of action for acute exacerbation, patient compliance to the prescribed treatment regimen is necessary to slow disease progression, reduce exacerbations, and improve quality of life. The knowledge of proper medication use (rescue pack) is improved and avoids risk factor. Additionally, the healthcare also reassesses inhalation technique due to poor skill. Patient satisfaction survey showed 88% COPD treatment of understanding and nurse clinic service of satisfaction was 92% after 1st visited integrated nurse clinic.
