Admissions

●All patients should have specialist resp assessment before O2 therapy start. ●Exception to this rule being those recieiving it for short term palliation.

●Specialist should also be reviewing the patient.

●If using O2 ≥ 2h per day, CONSIDER concentrators (ie using 5 or more cylinders a month)

●WYCSA may write to you about any patient on >5 cylinders per month about the change to a concentrator: you may wish to refer for hosp assessment to confirm their O2 needs

●fill in a single Home Oxygen Order Form (HOOF): click here for the form

●state whether long term, ambulatory or short burst oxygen

●State flow rate and usage hours needed

●The HOOF will remain extant until a new order is required to change the O2 therapy

●Get a consent form signed by patient to share info: click here for the form

●Send HOOF and consent directly to company

●This system should reduce the number of repeat prescriptions required of GPs

Notes

NBPCT COPD Nurse Specialist Services

This group of patients are most at risk of impaired quality of life relating to COPD and /or high usage of health service resources.

Who Can Refer?

Consultants, General Practitioners, Nurse Specialists. Nurse Practitioners / Practice Nurses, Crisis Intervention Team, Case Management Teams, Palliative Care Nurses, Community Hospital Matrons, District Nurses

Criteria for Referral

Clinical evidence of COPD together with spirometric measurement of FEV1 measuring 50% or lower than predicted.

They should also have at least three of the following criteria;

Two or more hospital admissions in the last 12 months with the primary diagnosis being exacerbation of COPD
Two or more A&E attendances in the last 12 months with the primary diagnosis being exacerbation of COPD
A hospital admission of 4 weeks or more with the primary diagnosis being exacerbation of COPD
Four or more visits to their practice in the last 12 months with needs relating to COPD (including home visits)
Dyspnoea measuring grade 4 or 5 on the MRC dyspnoea scale
Significant impairment in one or more major activity involved in daily living. E.g. personal hygiene.
Receiving oxygen therapy

Severe COPD should have their oxygen levels measured at least yearly to check their appropriateness for Long Term Oxygen Therapy. At present many Surgeries do not have access to this facility and so the only alternative is to refer patients to the acute trust for Consultant review. This is not only a waste of resources but also often inconvenient for the patient. Patients should be referred to the COPD specialist nurse for clinic review and if further assessments (arterial blood gases) they will be referred on.

The clinics may also be used as a resource so that patients may be referred for specialist advice when a consultant review is not deemed necessary.

The clinics will be held at Eccleshill hospital at present and so patients will need to be able to make their own way there. Please refer using the specific referral form available at most practices and note that Spirometry results are a pre requisite for referral. Please contact Robert Daw if you have any further questions.