CHRONIC OBSTRUCTIVE PULMONARY DISEASE CLINICAL PATHWAY QEH/HH PCH KCMH Souris Western Stewart Memorial O'Leary
PATIENT ID
INCLUSION CRITERIA All patients who are admitted to hospital and diagnosed with Chronic Obstructive Pulmonary Disease (COPD). EXCLUSION CRITERIA Patients under 18 years of age Patients diagnosed with Febrile Neutropenia or admitted to Critical Care.
HOW TO USE THE CLINICAL PATHWAY 1. This is a proactive tool to avoid delays in treatment and discharge. These are not orders, only a guide to usual orders. 2. Place the Clinical Pathway in the nurses clinical area of the chart. All health care professionals should fill in the master signature sheet at the front of the Pathway. Addressograph/sticker each page of the Pathway. 3 HEALTH CARE PROFESSIONALS: Initial tasks as completed. Bulleted and shaded sections do not need to be signed for on the pathway, but are to serve as a remider for consideration and to be completed as required. Additional tasks due to patient individuality can be added to the pathway in “OTHER” boxes and/or Progress Notes. 4 PATIENT TRANSFERS: If patient is transferred to another hospital in PEI or to home care or long-term care facility, send a copy of the following to the receiving site/agency:
Discharge Criteria - Original to stay on patient chart Teaching Checklist - Copy with patient in education packet - Original to stay on patient chart
Updated April 20, 2011
Adapted from Grey Bruce Health Network
Review November 1, 2011
NAME (Please Print)
INITIAL
Updated April 20, 2011
SIGNATURE
Adapted from Grey Bruce Health Network
TITLE
Review November 1, 2011
CHRONIC OBSTRUCTIVE PULMONARY DISEASE CLINICAL PATHWAY
Admitting Date / Time _______________________
PATIENT ID
COMORBID CONDITIONS:
PHASE 1
evening
day
night
INITIAL
day
DATE MET
night
ADMITTING VITALS
DATE ____________
evening
(Approximately 2 days)
PROCESS
DATE ____________
Respiratory rate < admitting rate Heart rate < admitting rate
PATIENT OUTCOMES
Once all Patient Outcomes are achieved, move to Phase 2
Temperature < admitting rate Dyspnea scale score < admitting rate Saturations achieved with less oxygen (flow or %) VS Q4H & PRN X 24H, including SpO 2 VS QID X 24H, including SpO 2 Chest assessment Q4H (breath sounds, productive cough) Dyspnea scale with activity
ASSESSMENT (OBSERVATIONS/ MEASUREMENTS/ ELIMINATION)
Dyspnea scale at rest Monitor intake / output Mental status (time, place, person)
Isolation: Droplet / Contact Precautions (if necessary) - Pneumococcal
Immunization History: - Influenza
CONSULTS
Yes No Unknown Yes No Unknown Yes No
Contact Physio Re: Breathing Exercises
Instructions for Dyspnea Scale: For Patients: "This is a scale that asks you to rate the difficulty of your breathing. It starts at 0 where your breathing is causing you no difficulty at all and progresses through to number 10 where your breathing difficulty is maximal. How much difficulty is your breathing causing you right now?" Severe breathlessness
Nothing at all Very, very slight breathlessness Very slight breathlessness
5 6 7
2
Slight breathlessness
8
3
Moderate breathlessness
9
Very, very severe breathlessness
4
Somewhat severe
10
Maximal breathlessness
0 0.5 1
Updated April 20, 2011
Adapted from Grey Bruce Health Network
Very severe breathlessness
Review November 1, 2011
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
PATIENT ID
PHASE 1
ABGs
ECG if ordered
ECG with chest pain, notify physician
Blood work as ordered
Blood culture X2 if ordered
Yes No N/A Yes No Yes No
Intermittent set / IV as ordered, reassess day 2
MEDICATIONS
Assess proper use of inhalers Medication Reconciliation
TREATMENTS/ INTERVENTIONS NUTRITION MOBILITY/ACTIVITY PSYCHOSOCIAL SUPPORT/ EDUCATION
Yes No
Oxygen to keep SpO 2 88-92 or as ordered
Assist personal hygeine
Regular diet or special diet ____________________________, Encourage fluids 2-3 litres/day BRPs with assistance, increase to AAT Walk in hallway Review Patient Pathway Start Teaching Checklist
Assess anxiety and intervene
Assess Discharge Criteria daily
DISCHARGE PLANNING
Assess for additional supports:
70 years old
Unstable secondary DX
Social situation
Medication compliance
Other:
Updated April 20, 2011
Adapted from Grey Bruce Health Network
Review November 1, 2011
evening
DIAGNOSTICS/ LABORATORY
day
Sputum for C&S if ordered CXR, PA & lateral
night
Bedside spirometry, if ordered
day
ADMISSION - ACUTE
night
(Approximately 2 days)
DATE ____________
evening
PROCESS
DATE ____________
CHRONIC OBSTRUCTIVE PULMONARY DISEASE CLINICAL PATHWAY
PATIENT ID
PHASE 2 (Approximately 3 days)
evening
day
night
evening
day
night
evening
INITIAL
DATE ___________
day
DATE MET
DATE ___________
night
PROCESS
DATE ___________
Off supplemental oxygen or on usual O2 if on chronic home oxygen Activity level as per preadmission
PATIENT OUTCOMES
Usual mental status
Once all Patient Outcomes are achieved, move to Discharge Criteria
Temp less than 38° c Dyspnea scale score improving On PO meds X 24 hours Understands diagnosis and discharge plan VS BID once stable, including SpO 2
ASSESSMENT (OBSERVATIONS/ MEASUREMENTS/ ELIMINATION)
Chest assessement Q4H (Breath sounds, Productive cough) Dyspnea scale with activity Dyspnea scale at rest Mental status (time, place, person) Monitor intake / output
Isolation: Droplet / Contact Precautions (if necessary)
Smoking cessation referral made, if necessary
Yes No N/A
Home O2 therapy referral, as needed
Yes No N/A
Repeat CXR if patient is not improving from Phase 1
Yes No N/A
CONSULTS
DIAGNOSTICS/ LABORATORY
Blood work as ordered
ABG’S if new home O 2 patient
Re-assess patient's proper use of inhalers
MEDICATIONS
Review discharge medications
Yes No
Intermittent set / IV as ordered
Updated April 20, 2011
Adapted from Grey Bruce Health
Review November 1, 2011
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
PATIENT ID
PHASE 2
DATE ___________
O2 if indicated - discontinue if SpO 2 in ordered range at rest and with activity
TREATMENTS/ INTERVENTIONS
Physio: Breathing Exercises
Yes No Date:____________
Assist with personal hygeine ,as necessary
Regular diet, or special diet __________ encourage fluids 2-3 litres/day
NUTRITION If tolerating diet, encourage snacks to meet increased nutritional needs from illness
MOBILITY/ACTIVITY
Increase activity as tolerated Review Patient Pathway
PSYCHOSOCIAL SUPPORT/ EDUCATION
Continue Teaching Checklist
Review handouts
Assess patient knowledge
Assess Discharge Criteria daily
DISCHARGE PLANNING
Equipment and supports arranged
Yes No N/A
Book follow-up appointment post-discharge
Yes No N/A
Review discharge plans with patient
Yes No N/A
Updated April 20, 2011
Adapted from Grey Bruce Health
Review November 1, 2011
evening
day
night
evening
day
night
evening
day
MAINTENANCE
DATE ___________
night
(Approximately 3 days)
PROCESS
DATE ___________
CHRONIC OBSTRUCTIVE PULMONARY DISEASE CLINICAL PATHWAY
PATIENT ID
DISCHARGE CRITERIA
PROCESS
DATE
INITIAL
Decreased sputum production and purulence from onset Resp
