Nottingham City Care Integrated Respiratory Service and Home

Nottingham City Care Integrated Respiratory Service and Home Oxygen Service Zoe Styles Senior Physiotherapist

INTEGRATED RESPIRATORY SERVICE Slide 2

Team structure • Team of staff including Nurses, Physiotherapists, Community Support workers and Administrators. • Assess and manage respiratory patients (with confirmed respiratory diagnosis) who have a GP in the Nottingham City area. Slide 3

Contact details • Patients should all have a pink card and can contact us between 0800 and 1900 • Contact number 0115 8833622 Slide 4

Elements of Service • Acute nursing visits • Post hospital discharge visits • Case Management • Nursing clinics • Pulmonary Rehabilitation • Acute Physiotherapy • Domiciliary Physiotherapy Slide 5

Acute nursing visits • Patients contact the service using their pink card • Patients speak to a triage nurse to assess and establish if a visit is needed • Patients seen in their own home within 4 hours • Nurses complete a holistic assessment including respiratory assessment and guide on treatment as appropriate Slide 6

Acute visits continued • Short term nebuliser loan • Working in partnership with other agencies (e. g. GP practice team, social services) • Access to respiratory assessment unit. • Follow up as indicated by clinical need. Slide 7

Post Hospital Discharge Visits • Referrals from NUH for all respiratory patients on discharge • Telephone call to arrange an visit and discuss wellbeing • Holistic assessment • Referral to other aspects of the service as required (e. g. Pulmonary Rehabilitation) Slide 8

Case management • Visits in patients own home, regular visits as required • Aim to prevent hospital admissions • Education and advice • Medicines review • Referral in to other aspects of the service as appropriate Slide 9

Nursing clinics • Patients seen in clinics across the city (Bulwell riverside, Grange Farm, St Anns Valley Centre, Clifton Cornerstone) • Clinics to assess suitability for Pulmonary Rehabilitation • Respiratory review of patients able to attend clinic • Spirometry (for patients with complex needs or struggled with previous attempts) Slide 10

Pulmonary Rehabilitation • Classes run at Beechdale Community Centre, Bulwell Riverside, Clifton Cornerstone and St Anns Valley Centre • Assessments run at each venue weekly • Rolling Programme • Post exacerbation Slide 11

Pulmonary Rehabilitation continued • Sessions consist of exercise and education sessions • Each session is lead by a physiotherapist who will prescribe exercise based on a detailed assessment. • Education sessions include, benefits of exercise, What is happening in my lungs? , breathing control, chest clearance, medicines, inhaler technique, anxiety management, nutrition, energy conservation, dangers of smoking, community services, British lung foundation, managing exacerbations. Slide 12

Acute physiotherapy • Patients in exacerbation referred when struggling to clear their chests • Holistic assessment including respiratory assessment • Chest clearance and breathlessness management. • Follow up arranged as appropriate Slide 13

Domiciliary Physiotherapy • Home exercise programmes • Chest clearance • Breathlessness management Slide 14

HOME OXYGEN SERVICE ASSESSMENT AND REVIEW Slide 15

What we do: • Assess patients for LTOT & Ambulatory • Review patients with oxygen • Blood gases • Oxygen removal • All oxygen assessments completed in the patients own home Slide 16

Referral Criteria • Oxygen saturations consistently below 92% • Significant desaturation on exertion • 8 weeks clear of antibiotics / exacerbation • Not smoking • Already has oxygen Slide 17

Oxygen Facts • Oxygen is not used to treat breathlessness or anxiety • Blood gases need to be performed prior to prescription of oxygen • Oxygen should not be prescribed if patient is smoking • It is a medication • Can be harmful/fatal if used incorrectly or unnecessarily Slide 18

Oxygen Facts continued • Patients must be on optimal medication • Referral to the service is for oxygen assessment and oxygen may not be indicated. This will be discussed during the assessment process • Oxygen can be delivered via nasal cannula or mask • Oxygen safety is discussed with all patients (e. g. it must not be used near naked flame including gas cooker, trailing oxygen tubing) Slide 19

Patients not on oxygen • Seen to assess need at very first visit • Blood gases in clinic for baseline and assessment of clinical indication • If blood gases indicate oxygen: titrate for LTOT • If blood gases do not indicate oxygen: assess for ambulatory • Oxygen saturations must be consistently below 92% to merit assessment Slide 20

LTOT Patients • Patients reviewed 12 monthly at home • Blood gases and home review completed • Oxygen needs change – patients on oxygen may not need it forever and it may be removed • Therapy is for minimum of 16 hours through a concentrator Slide 21

Blood Gases • Small sample of blood from patient’s ear lobe • Analysed there and then • To assess need for oxygen 2 baseline readings must be obtained • Patients must be stable and 8 weeks clear of antibiotics and steroids • Maintenance antibiotics or steroids are ok Slide 22

Ambulatory assessments • Rehab setting only • Patients must have blood gas prior to assessment • For moderate to high level activity patients • Assessed by walking tests • Patients can have ambulatory without LTOT but this must be indicated by the tests Slide 23

Palliative patients • Still need a blood gas before prescribing • Must have hypoxic need not just breathless • Encourage fan therapy/breathing control/inhalers for breathlessness Slide 24

Short Burst • No clinical benefit therefore should not be prescribed • No longer fits with national guidelines Slide 25

Removal • When there is no clinical indication e. g. blood gases • If a patient is still smoking • Education on alternatives for breathlessness e. g. fan therapy • Follow up of oxygen saturations or blood gases 4 months later • Education on risks of using oxygen without clinical need Slide 26

Nottingham City. Care Partnership CIC 1 Standard Court Park Row Nottingham NG 1 6 GN e: citycare@nottinghamcitycare. nhs. uk t : 0115 883 9600 www. nottinghamcitycare. nhs. uk