Managing an Exacerbation of Your Chronic Obstructive Pulmonary Disease Patient held record and self-management plan Keep this in a safe place and bring it with you to GP or hospital visits, including admissions. Exceptional healthcare, personally delivered
Contents Page Personal details... 2 Health Care Professional Contact Details... 3 List of Medication (long term)... 4 Nebulised Medicines / Inhalers... 4 Oxygen Therapy... 4 Rescue Pack Medicines and Instructions... 4 Recognising that you have an exacerbation of COPD... 5 What action to take... 6 Signs of deterioration and what to do... 6 If you need admission to hospital what you can expect to happen... 7 Planning your discharge from hospital... 8 For advice on managing breathlessness and long term problems please see Living with a Chronic Lung Disease leaflet
Personal details Name: Address: Telephone: NHS Number: Hospital Number: Next of kin: Carers details: 2
Health care Professional Contact Details GP - Dr... Tel:... Out of Hours GP Dial 111 Community Matron... Tel:... Respiratory Specialist Team... Tel:... Ensure that you have at least, a yearly review with your GP/practice nurse and have your flu vaccination every year. It is also advisable to have the pneumococcal vaccination. Please discuss this with you GP/practice nurse. 3
List of Medication (Attach up to date repeat prescription list if available).................. Long Term Inhaled and Nebulised Medication Drug Name Inhaler / Nebuliser Frequency Reason................................................ Home Oxygen Therapy Prescription (if applicable) Long Term Oxygen Therapy (LTOT)...L/min...Hrs/day Short Burst Oxygen Therapy (SBOT)...L/min...Hrs/day Ambulatory Oxygen ( liquid / cylinders)...l/min...hrs/day Rescue Pack Medication (Kept at home, please follow instructions with pack if provided) Antiobiotic... Instructions... Oral Steroids... Instructions... 4
Recognising that you have an exacerbation of COPD To view a sputum colour chart, turn to the back of this leaflet. An exacerbation means a flare up or worsening of your COPD symptoms. The reason for the exacerbation may not be known. Early medical treatment will prevent it from getting worse! How to identify an exacerbation/flare-up and what to do: You may not get all of these symptoms but two or more of these symptoms below may indicate a flare-up n Increased breathlessness more breathless or more wheezy than normal causing difficulties managing your normal daily activities, such as ability to climb stairs or walking distance n Increased cough n Increased quantity of sputum (phlegm) n Change in colour of sputum (phlegm) n Fever n Swollen ankles and legs n Increased tiredness 5
What action to take: n Contact your GP or community matron for advice as soon as possible. n Increase the use of your short acting inhaler or nebuliser n Reduce / pace activity levels to manage your necessary activities of daily living. n Increase your breathing / chest clearance exercises. n Start your rescue medication pack as agreed / instructed. n Early intervention and treatment is important when you have worsening symptoms. n You should see an improvement within three days. n However if your condition worsens at any point, contact your GP (Out of hours if necessary by dialling 111). Inform your doctor that you have commenced treatment. Be aware of signs of deterioration (Please also discuss this with your family / carers) n Chest Pain Dial 999 n Increased shortness of breath that doesn t settle with reliever medication (inhaler or nebuliser) and pacing activities or change of position n Confusion or feeling drowsy n Unable to cope with current level of support / required level of activities of daily living n Fever / Feeling cold and shivery, flu like symptoms n Increased sputum or change in colour (becoming more green / yellow, infected looking) after starting treatment. 6
What to expect if your health care team feel you need admission to hospital to manage your exacerbation of COPD You may be referred to the HOT Clinic by your GP or nurse. This is a service offered at Southmead Hospital Bristol by the respiratory team Monday to Friday. If your condition is deteriorating they will see you and assess you either the same day or next day to try and avoid the need for hospital admission. You will be offered the same treatment and support as you would receive on admission. However, if you are more unwell or it is out of hours you may be admitted to hospital with an exacerbation of your COPD. Your care will be provided following national guidelines in the form of a care bundle. You can expect: A chest x-ray and ECG (heart trace) within 4 hours Your observations including oxygen levels recorded and oxygen prescribed if needed. If your oxygen levels are considered low (below 94%) you may have an arterial blood gas performed when a blood sample is taken from the artery in your wrist to assess your respiratory function and oxygen levels. If required you will be prescribed steroids, antibiotics and nebulisers within 4 hours of admission. The steroids and antibiotics may be in the form of tablets or if your condition is more severe this may be through a drip in your arm. You should see either a Respiratory Consultant or a member of the Respiratory Specialist Team within 24 hours. It will be considered at this time if you may be suitable for care under the Early Supported Discharge (ESD) Team. This is a service to enable the early supported discharge of patients with COPD by offering them care at home by a specialist team. If possible please take your inhalers to hospital with you or arrange for a friend or relative to bring them in as soon as possible. Please also take your usual medications. 7
If your condition deteriorates in hospital If you are very unwell the medical team may consider that you need assistance with your breathing with the use of Non Invasive Ventilation (NIV). You may also hear this referred to as BiPAP. This is a system that is used on the acute medical / respiratory wards where controlled oxygen or air can be delivered via a tight fitting mask under slight pressure. This can help significantly in the early treatment of an exacerbation and prevent the need for full ventilation in the Intensive Care Unit. It can also be used when it is not deemed appropriate for you to go to the Intensive Care Unit. This may be due to your own personal wishes or because the doctors do not feel this would be beneficial to your long term condition. These decisions would always be made with you and your family and please feel free to discuss this at any time with any member of your health care team. It can be useful to think about issues relating to your level of care and what your personal wishes and concerns are should you become very unwell. It is important that you discuss this with your family, carers and health care team so people are aware of your wishes. Discharge Planning Once you are clinically stable the staff will already be thinking about planning your discharge. This may feel unusual if you are still unwell but planning ahead can make the process much smoother and less stressful for you. They will provide you with the leaflet Planning your safe and timely hospital discharge or transfer. This may take the form of assessment by the Early Supported Discharge team for COPD or if your hospital stay has been longer you will need to consider the following. 8
n The Enhanced Recovery in COPD pathway will help you realise what is needed before it is safe for you to return home (or prior to discharge from the Early Supported Discharge team if you have been under their care). This includes: - A review of your medications (including ability to take them) and your inhaler technique - A rescue pack of emergency antibiotics and steroids - An Oxygen alert card if applicable - Assessment and referral for smoking cessation if applicable - Assessment and referral for Pulmonary Rehabilitation if applicable n If you will need any additional support at home please discuss this with a member of your health care team, at the earliest opportunity. Please also inform them of care services you already receive n Transport home Who will be able to collect you? Please have contact numbers available for family and friends. n Suitable clothing for the journey home. n Keys to your home. n Provision of food and drink once at home who can help with shopping and cooking? n Medications do you have a supply of your normal medicines / inhalers at home or do you need more before being discharged? n On-going support needed at home and what follow up you will receive. You will receive a follow-up phone call from a member of the respiratory specialist team within 72 hours of discharge from hospital or from the early supported discharge team. 9
References Chronic Obstructive Pulmonary Disease : National clinical guideline for management of COPD in adults in primary and secondary care. 2010 Borg G. (1982) Psychophysical bases of perceived exertion. British Lung Foundation: COPD Self management plan. 2008. Hough, A. (2000) Physiotherapy in Respiratory Care: an evidence based approach (3rd edition). Enhanced Recovery Patient Diary for an Exacerbation of COPD leaflet, NBT Living with a chronic lung condition leaflet, NBT Early Supported Discharge Team for COPD leaflet, NBT NHS Constitution. Information on your rights and responsibilities. Available at www.nhs.uk/aboutnhs/constitution 10
Notes / Questions Please use this space to write down any reminders for yourself or questions you may have for your medical team. 11
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Sputum colour chart 13
www.nbt.nhs.uk/respiratory If you or the individual you are caring for need support reading this leaflet please ask a member of staff for advice. North Bristol NHS Trust. This edition published May 2014. Review due May 2016. NBT002295