COPD Care Pathway Audley Mills Surgery
Avoiding Unscheduled admissions
For the purposes of QP indicators a care pathway is a defined process of diagnosis, treatment and care for a defined group of patients during a defined period.
TITLE OF PATHWAY / COPD – avoiding unscheduled admissions1 Define Patient Group
(age, sex, symptom, diagnosis) / Patients with moderate to very severe COPD defined as FEV1/FVC ratio less than 70 % and FEV1<50% predicted
2 Define steps required for diagnosis (flowchart) / Spirometry is necessary to confirm diagnosis and severity in accordance with NICE guidance
http://www.nice.org.uk/nicemedia/live/13029/49399/49399.pdf
3 Define treatment protocol / The main purpose of this pathway is to ENCOURAGE EARLY SELF MANAGEMENT OF EXACERBATIONS OF COPD to prevent avoidable hospital admissions in accordance with NICE guidance:
Encourage people at risk of having an exacerbation to respond quickly to the symptoms of an exacerbation by:
– starting oral corticosteroid therapy (unless contraindicated) if increased breathlessness interferes
with activities of daily living
– starting antibiotic therapy if their sputum is purulent
– adjusting bronchodilator therapy to control symptoms.
Give people at risk of exacerbations a course of antibiotic and corticosteroid tablets to keep at
home. Monitor the use of these drugs and advise people to contact a healthcare professional if their
symptoms do not improve.
Self Management Plan given to all moderate to severe COPD patients – includes standby antibiotics and steroids available for use in exacerbation
Acute exacerbation identified by increased SOB, increased sputum or change in sputum colour
If not improving or if GP opinion required then consider the following to decide if hospital admission required (see flowchart)
4 Define other care elements necessary / Alternatives to admission include:
· Rapid Response Team
· Intermediate Care Ward (Princess Anne Ward)
· Collaborative Care Team
5 Define end point of care pathway (duration) / After the exacerbation ends, patient is reviewed by GP to document episode, ensure self management plan is appropriate and update prescription for standby antibiotics and steroids.
Some may consider this step unnecessary – I believe most of these patients will be seen anyway, and this ensures Read Coding of exacerbations. It will identify those patients who need alternative management strategies.
6 Audit / Annual audit of COPD acute admissions (frequency and appropriateness) and overall COPD exacerbation rate (all exacerbations to be Read Coded as Acute Exacerbation of COAD Y5284 (shortcut = ‘exac’)