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Monitoring Recovery and Early Assisted Discharge for COPD Pathway
Patient Improving
Complete End Stage COPD Assessment Tool for Respiratory Patients 
Is patient identified as End Stage COPD?
Yes
Follow the End Stage COPD Pathway
End Stage COPD PathwayDoes patient meet criteria for Hospital at Home Support?
Medical Criteria |
| Diagnosis of COPD with Acute Exacerbation |
| Bronchiectatic patient who do not require IV Antibiotics |
| Acceptance of mild pneumonias or resolving pneumonias to provide on-going support at home ( CURB score 1-2) |
| Agreement of GP/Consultant/SpR. |
| Agreement of COPD Hospital@Home team |
| In patient Referral only - Blood Gases – In patient = pH > 7.35 on air pO2 > 7 kPa on air pCO2 < 6.5 kPa on air |
| Primary Care Referral only - Blood Gases can be taken within 24 hours via PCAU/Ambulatory Care/Community Access if previous exacerbation is within 6 weeks? |
| Basic Observations RR < 25 Temp < 38 HR < 110 Systolic BP > 100 mmHg SpO2 > 90% on air (unless normal for patient) (unless normal for patient) |
| In patient Referral only - No new CXR or ECG changes , Bloods ( FBC, Biochemistry INR) Confirmed by Consultant as within acceptable limits for scheme |
| Primary Care Referral only – CXR and ECG can be completed within 24 hours if previ-ous exacerbation is within 6 weeks Bloods ( FBC, Biochemistry INR) |
No confusion and normal conscious level |
| No worsening of peripheral oedema. |
| Are co morbidities stable? |
| Is the Patient only receiving oral or nebulised treatment for COPD? |
| Stable on established home oxygen |
| Social Criteria |
| Patient consents to COPD Hospital@Home |
| If patient lives alone is family/carer support required? |
| Has the patient Telephone Access or Vitaline/Helpline? |
| Is the patient medically fit for early supported discharge? |
Yes
Refer to Respiratory Nurses for Hospital @
Home (formerly ESD)
RNS Liaise with Rapid Response Team regarding Hospital @ Home if appropriate
No
Refer to Respiratory Nurses for self management and education review:
- Optimisation of inhalers
- O2 Assessment
Complete COPD Discharge Care Bundle
- Smoking Advice
- Pulmonary Rehabilitation
- Patient Information
- Inhaler Technique
- Outpatient/Follow up
Ongoing Care
- Patients' recovery should be monitored by regular clinical assessment of their
symptoms and observation of their functional capacity - Pulse oximetry should be used to monitor the recovery of patients with non
hypercapnic, non-acidotic respiratory failure. - Pulse oximetry should be used to monitor the recovery of patients with non
hypercapnic, non-acidotic respiratory failure.
Referral to GP/Community Matron for follow-up Spirometry after discharge
Patients who have had an episode of respiratory failure should havesatisfactory oximetry or arterial blood gas results before discharge.
Does patient have a 'My Breathing Book' Self Management Plan?
Yes
Update ‘My Breathing Book’ to reflect admission
- Patients should be re-established on their optimal maintenance
bronchodilator therapy before discharge (e.g. nebulisers reverted to
usual inhalers) - O2 weaned off as appropriate if unable to wean ABG’s on room air
- All aspects of the routine care that patients receive (including
appropriateness and risk of side effects) should be assessed before
discharge.
No
Respiratory Nurses will
initiate ‘My Breathing
Book’ or alternate self
management plan if
appropriate