1 NES Initial COPD Management Training for GPNs Assessment Handbook NES General Practice Nursing Learning & Development Coordinated Network Initial COPD Training for General Practice Nurses to Undertake Annual COPD Reviews Assessment Handbook For Participants 2018 Assignment due: 5 th July 2018 Course Leaders: Gill Dennes. RGN. BA (Hons) MSc Gill Dennes. RGN. BA (Hons) MSc (Primary Care) ANP Clinical lead for Fife Respiratory MCN NES GPN Education Advisor for Fife. [email protected]Vicki Waqa RGN. Ba (Hons). NHS Education for Scotland Specialist Educator [email protected]Course Aim: To provide general practice nurses with the knowledge and skills to perform an annual review of COPD in primary care.
Transcript
1 NES Initial COPD Management Training for GPNs Assessment Handbook
NES General Practice Nursing
Learning & Development Coordinated Network
Initial COPD Training for
General Practice Nurses to Undertake
Annual COPD Reviews
Assessment Handbook
For Participants
2018
Assignment due: 5th
July 2018
Course Leaders:
Gill Dennes. RGN. BA (Hons) MSc
Gill Dennes. RGN. BA (Hons) MSc (Primary Care) ANP Clinical lead for Fife
Respiratory MCN NES GPN Education Advisor for Fife.
2 NES Initial COPD Management Training for GPNs Assessment Handbook
Section 1: Course Forms
Participant name:
Current role in COPD management e.g. participating in COPD reviews (for how long?):
Summary of learning
Date completed:
Commencement of training
15th March 2018
Completion of 2-day theoretical course
24th May 2018
Submission of first Reflective Account Formative
Date: By 17th May 2018
Submission of second Reflective Account Summative
Date: 5th July 2018
Result of DOPS
Date:
Completion of 5 COPD annual reviews
Submission of supervisors written competency statement
Submission of personal review of the five COPD reviews submitted
Date:
Date of satisfactory completion of training Supervisor comments: Participant comments:
Nurses’ Personal Record Document
3 NES Initial COPD Management Training for GPNs Assessment Handbook
Comment if required from supervisor:
This is to certify that ________________________________________________
has satisfactorily completed 5 COPD annual reviews and has demonstrated the
competencies required in accordance with the NMC Code of Practice (2015) and national
COPD guidelines.
Signature of participant __________________________________Date:
Signature of supervisor __________________________________Date:
4 NES Initial COPD Management Training for GPNs Assessment Handbook
Worksheets for Review of Five Non Complex COPD
Reviews in General Practice
Example Worksheet:
Worksheets for Review of Non Complex COPD Reviews in General Practice
You should first observe at least two COPD reviews with your supervisor following your first taught day. When you are considered able to begin undertaking COPD reviews please carry out five with supervision. The following worksheets are for you to record these five COPD reviews for an individual diagnosed with non-complex COPD. That is a patient called in for an annual review rather than a patient presenting with, or post, an exacerbation of their condition. It is suggested that you discuss with your supervisor who would be appropriate patients to review. In keeping with the NMC Code all information on these sheets should be anonymised and not recognisable e.g. names of patients, staff, and places. Also please ask the patient’s permission to use them as part of your learning. These worksheets should be submitted after Day 2 to support your second piece of reflection. The following review is an example of how to present your reviews.
Participant name: Anon Person
NMC number:
Supervisor name:
AN Other
Date of NES Short Course
15th March 2018 and 24th May 2018
Number of Annual Review
Example (eg 1)
Consultation Process
Participant’s Notes
Introduction and check identity of patient against their medical records.
e.g. describe the patient 76 year old male. BMI 24. Height 175 cms Smoker 30 pack years. Alcohol intake 10 units/wk. Never exercises, family help with housework and shopping as he gets breathless walking 100 yards or few minutes on level. Osteoarthritis affecting both knees. Medication: Salbutamol inhaler; long acting anti muscarinic dry powder one dose daily; co-codamol30/500 1-2 four x daily
Assess current control by demonstrating and observing spirometry, pulse oximetry, assessing MRC score and use of COPD Assessment Tool
e.g. any symptoms? Use of inhalers? Results of assessment? Breathless on exertion especially bending, walking short distances, washing and dressing. Daily cough productive of clear mucus, worse in mornings. Often wheezy. CAT score 14/30. FEV1 55% predicted (a
5 NES Initial COPD Management Training for GPNs Assessment Handbook
decline of 10% in last year). Pulse oximetry 96% when stable. MRC 4. Uses SABA 4x a day on average. Takes LAMA daily.
Assess smoking status; if appropriate calculate the pack years and offer smoking cessation advice
e.g. outcome of assessment and discussion Discussed smoking and other lifestyle factors asking which he would, if any, like to deal with at this present time in his life. Often feels low in mood and socially isolated and does not wish to stop smoking but will consider attending pulmonary rehabilitation. Discussed effect of continued smoking on accelerated decline in lung function with subsequent symptoms. Smoking cessation advice offered if he wishes to take this up in the future.
Identify the number of COPD exacerbations in the last year and expose any trigger factors, providing appropriate advice to reduce or remove exposure
e.g. previous history, triggers and advice given One COPD exacerbation noted in past year, treated with oral antibiotics and steroids. Triggers: Viral upper respiratory tract infections, cold,damp weather Discussed importance of prompt recognition and management of exacerbations
Identify the number of oral steroid courses in the last year and interpret the risk factors in regard to osteoporosis and other co-existing pathologies
e.g. no. of courses and list risk factors if any. One course of oral steroids in last year and no inhaled steroids at present. No indication for DEXA scan at present
Establish adherence to medication and offer advice and options if adherence sub-optimal.
e.g. how many prescriptions requested for each inhaler Discussed his prescription history – taking regular co-codamol for arthritic pain and often constipated. Discussed diet/fluid intake and increased activity to reduce constipation. Using salbutamol appropriately but inhaler technique poor. Dry powder inhaler technique good.
Identify the number of hospital admissions in the last year
e.g. analyse no. of admissions, reasons and follow up No hospital admissions in past year.
Demonstrate, observe and assess inhaler technique; modifications advised if appropriate. Alternative devices discussed if required.
e.g. general comments on inhaler use, teach back, Patient had brought inhalers with him to the appointment so he demonstrated his use of them. Did not use seven step technique and found coordination difficult with the MDI. Use of spacer explained and demonstrated – he found this easier to manage and was able to access the medication from it with more efficacy and ease of use, making him feel empowered and enabled. Used Teach back to ensure he was able to use both his devices effectively.
Provide a medication review:
e.g. medication step up or down? Discussed the need for increased bronchodilation medication in order to control his symptoms and agreed that he would switch to LABA/LAMA combination.No
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indication for inhaled corticosteroid at present.
Discuss general well-being which might influence COPD control and proceed as appropriate
e.g. any co-morbidities, healthy lifestyle As discussed above, he would like to try increasing his physical activity at present rather than stop smoking. He was referred to Pulmonary Rehabilitation. We discussed the ‘cycle of inactivity and increased breathlessness’ and encouraged patient to share this information with family (given relevant BLF/CHSS resources). We assessed low mood and offered support/referral to consider pharmacological intervention if necessary.
Provide a negotiated written Personal COPD Action Plan
e.g. describe negotiation and where appropriate attach anonymised example with patient permission. It was important to ensure that he had a COPD Action Plan in place to know what to do in the event of an exacerbation. We discussed the plan together and filled in the three areas of increasing symptoms and what to do, and a home supply of antibiotics and oral steroids was organised.
Refer to appropriate practitioner with any findings requiring further investigation and follow-up
e.g. follow up arranged, type of referral if appropriate and outcome 1. Pulmonary Rehabilitation Community Team 2. GP re low mood and consideration of eKIS 3. Local Breathe Easy Support Group
Record findings of COPD review in patient’s medical records
e.g. which computer system used, any other methods used All findings were documented using the GP template for audit purposes and then text added into the EMIS consultation and saved.
7 NES Initial COPD Management Training for GPNs Assessment Handbook
Worksheets for Review of Five Non Complex COPD Reviews in General Practice
Worksheets for Review of Non Complex COPD Reviews in General Practice
These worksheets should be submitted after Day 2 to support your second piece of reflection.
Participant name:
NMC number:
Supervisor name:
Date of NES Short Course
Number of Annual Review
1
Consultation Process
Participant’s Notes
Introduction and check identity of patient against their medical records.
e.g. describe the patient
Assess current symptoms by using the MRC and CAT tools
e.g. any symptoms? Use of inhalers? Results of assessment?? where recorded predicted and best
Assess smoking status; if appropriate calculate the pack years and offer smoking cessation advice
e.g. outcome of assessment and discussion
Observe and demonstrate spirometry and pulse oximetry, interpreting results if appropriate
e.g. use of spirometer and pulse oximeter
Identify the number of COPD exacerbations in the last year
e.g. flare ups; chest infections – reported and unreported, including hospital admissions
Identify the number of oral steroid courses in the last year and interpret the risk factors in regard to osteoporosis and other co-existing pathologies
e.g. no. of courses and list risk factors for osteoporosis using FRAX tool
Establish adherence to medication and offer advice and options if adherence sub-optimal.
e.g. how many prescriptions requested for each inhaler
8 NES Initial COPD Management Training for GPNs Assessment Handbook
Demonstrate, observe and assess inhaler technique; modifications advised if appropriate. Alternative devices discussed if required.
e.g. general comments on inhaler use, teach back, two tone technique
Demonstrate pharmacological management
e.g. medication step up in accordance with guidelines
Discuss general well-being which might influence COPD control and proceed as appropriate
e.g. any co-morbidities, healthy lifestyle
Provide a negotiated written Personal Action Plan
e.g. describe negotiation and where appropriate attach anonymised example with patient permission.
Refer to appropriate practitioner with any findings requiring further investigation and follow-up
e.g. follow up arranged, type of referral if appropriate and outcome, including pulmonary rehabilitation
Explain the role of physical activity and the cycle of inactivity
e.g. using behaviour change techniques
Record findings of COPD review in patient’s medical records
e.g. which computer system used, any other methods used
9 NES Initial COPD Management Training for GPNs Assessment Handbook
Worksheets for Review of Five Non Complex COPD Reviews in General Practice
Worksheets for Review of Non Complex COPD Reviews in General Practice
These worksheets should be submitted after Day 2 to support your second piece of reflection.
Participant name:
NMC number:
Supervisor name:
Date of NES Short Course
Number of Annual Review
2
Consultation Process
Participant’s Notes
Introduction and check identity of patient against their medical records.
e.g. describe the patient
Assess current symptoms by using the MRC and CAT tools
e.g. any symptoms? Use of inhalers? Results of assessment?? where recorded predicted and best
Assess smoking status; if appropriate calculate the pack years and offer smoking cessation advice
e.g. outcome of assessment and discussion
Observe and demonstrate spirometry and pulse oximetry, interpreting results if appropriate
e.g. use of spirometer and pulse oximeter
Identify the number of COPD exacerbations in the last year
e.g. flare ups; chest infections – reported and unreported, including hospital admissions
Identify the number of oral steroid courses in the last year and interpret the risk factors in regard to osteoporosis and other co-existing pathologies
e.g. no. of courses and list risk factors for osteoporosis using FRAX tool
Establish adherence to medication and offer advice and options if adherence sub-optimal.
e.g. how many prescriptions requested for each inhaler
10 NES Initial COPD Management Training for GPNs Assessment Handbook
Demonstrate, observe and assess inhaler technique; modifications advised if appropriate. Alternative devices discussed if required.
e.g. general comments on inhaler use, teach back, two tone technique
Demonstrate pharmacological management
e.g. medication step up in accordance with guidelines
Discuss general well-being which might influence COPD control and proceed as appropriate
e.g. any co-morbidities, healthy lifestyle
Provide a negotiated written Personal Action Plan
e.g. describe negotiation and where appropriate attach anonymised example with patient permission.
Refer to appropriate practitioner with any findings requiring further investigation and follow-up
e.g. follow up arranged, type of referral if appropriate and outcome, including pulmonary rehabilitation
Explain the role of physical activity and the cycle of inactivity
e.g. using behaviour change techniques
Record findings of COPD review in patient’s medical records
e.g. which computer system used, any other methods used
11 NES Initial COPD Management Training for GPNs Assessment Handbook
Worksheets for Review of Five Non Complex COPD Reviews in General Practice
Worksheets for Review of Non Complex COPD Reviews in General Practice
These worksheets should be submitted after Day 2 to support your second piece of reflection.
Participant name:
NMC number:
Supervisor name:
Date of NES Short Course
Number of Annual Review
3
Consultation Process
Participant’s Notes
Introduction and check identity of patient against their medical records.
e.g. describe the patient
Assess current symptoms by using the MRC and CAT tools
e.g. any symptoms? Use of inhalers? Results of assessment?? where recorded predicted and best
Assess smoking status; if appropriate calculate the pack years and offer smoking cessation advice
e.g. outcome of assessment and discussion
Observe and demonstrate spirometry and pulse oximetry, interpreting results if appropriate
e.g. use of spirometer and pulse oximeter
Identify the number of COPD exacerbations in the last year
e.g. flare ups; chest infections – reported and unreported, including hospital admissions
Identify the number of oral steroid courses in the last year and interpret the risk factors in regard to osteoporosis and other co-existing pathologies
e.g. no. of courses and list risk factors for osteoporosis using FRAX tool
Establish adherence to medication and offer advice and options if adherence sub-
e.g. how many prescriptions requested for each inhaler
12 NES Initial COPD Management Training for GPNs Assessment Handbook
optimal.
Demonstrate, observe and assess inhaler technique; modifications advised if appropriate. Alternative devices discussed if required.
e.g. general comments on inhaler use, teach back, two tone technique
Demonstrate pharmacological management
e.g. medication step up in accordance with guidelines
Discuss general well-being which might influence COPD control and proceed as appropriate
e.g. any co-morbidities, healthy lifestyle
Provide a negotiated written Personal Action Plan
e.g. describe negotiation and where appropriate attach anonymised example with patient permission.
Refer to appropriate practitioner with any findings requiring further investigation and follow-up
e.g. follow up arranged, type of referral if appropriate and outcome, including pulmonary rehabilitation
Explain the role of physical activity and the cycle of inactivity
e.g. using behaviour change techniques
Record findings of COPD review in patient’s medical records
e.g. which computer system used, any other methods used
Worksheets for Review of Five Non Complex COPD
Reviews in General Practice
Worksheets for Review of Non Complex COPD Reviews in General Practice
These worksheets should be submitted after Day 2 to support your second piece of reflection.
Participant name:
NMC number:
Supervisor name:
Date of NES Short Course
Number of Annual Review
4
13 NES Initial COPD Management Training for GPNs Assessment Handbook
Consultation Process
Participant’s Notes
Introduction and check identity of patient against their medical records.
e.g. describe the patient
Assess current symptoms by using the MRC and CAT tools
e.g. any symptoms? Use of inhalers? Results of assessment?? where recorded predicted and best
Assess smoking status; if appropriate calculate the pack years and offer smoking cessation advice
e.g. outcome of assessment and discussion
Observe and demonstrate spirometry and pulse oximetry, interpreting results if appropriate
e.g. use of spirometer and pulse oximeter
Identify the number of COPD exacerbations in the last year
e.g. flare ups; chest infections – reported and unreported, including hospital admissions
Identify the number of oral steroid courses in the last year and interpret the risk factors in regard to osteoporosis and other co-existing pathologies
e.g. no. of courses and list risk factors for osteoporosis using FRAX tool
Establish adherence to medication and offer advice and options if adherence sub-optimal.
e.g. how many prescriptions requested for each inhaler
Demonstrate, observe and assess inhaler technique; modifications advised if appropriate. Alternative devices discussed if required.
e.g. general comments on inhaler use, teach back, two tone technique
Demonstrate pharmacological management
e.g. medication step up in accordance with guidelines
Discuss general well-being which might influence COPD control and proceed as appropriate
e.g. any co-morbidities, healthy lifestyle
Provide a negotiated written Personal Action Plan
e.g. describe negotiation and where appropriate attach anonymised example with patient permission.
Refer to appropriate practitioner with any findings requiring further investigation and follow-
e.g. follow up arranged, type of referral if appropriate and outcome, including pulmonary rehabilitation
14 NES Initial COPD Management Training for GPNs Assessment Handbook
up
Explain the role of physical activity and the cycle of inactivity
e.g. using behaviour change techniques
Record findings of COPD review in patient’s medical records
e.g. which computer system used, any other methods used
15 NES Initial COPD Management Training for GPNs Assessment Handbook
Worksheets for Review of Five Non Complex Asthma
Reviews in General Practice
Worksheets for Review of Non Complex COPD Reviews in General Practice
These worksheets should be submitted after Day 2 to support your second piece of reflection.
Participant name:
NMC number:
Supervisor name:
Date of NES Short Course
Number of Annual Review
5
Consultation Process
Participant’s Notes
Introduction and check identity of patient against their medical records.
e.g. describe the patient
Assess current symptoms by using the MRC and CAT tools
e.g. any symptoms? Use of inhalers? Results of assessment?? where recorded predicted and best
Assess smoking status; if appropriate calculate the pack years and offer smoking cessation advice
e.g. outcome of assessment and discussion
Observe and demonstrate spirometry and pulse oximetry, interpreting results if appropriate
e.g. use of spirometer and pulse oximeter
Identify the number of COPD exacerbations in the last year
e.g. flare ups; chest infections – reported and unreported, including hospital admissions
Identify the number of oral steroid courses in the last year and interpret the risk factors in regard to osteoporosis and other co-existing pathologies
e.g. no. of courses and list risk factors for osteoporosis using FRAX tool
Establish adherence to medication and offer advice and options if adherence sub-optimal.
e.g. how many prescriptions requested for each inhaler
16 NES Initial COPD Management Training for GPNs Assessment Handbook
Demonstrate, observe and assess inhaler technique; modifications advised if appropriate. Alternative devices discussed if required.
e.g. general comments on inhaler use, teach back, two tone technique
Demonstrate pharmacological management
e.g. medication step up in accordance with guidelines
Discuss general well-being which might influence COPD control and proceed as appropriate
e.g. any co-morbidities, healthy lifestyle
Provide a negotiated written Personal Action Plan
e.g. describe negotiation and where appropriate attach anonymised example with patient permission.
Refer to appropriate practitioner with any findings requiring further investigation and follow-up
e.g. follow up arranged, type of referral if appropriate and outcome, including pulmonary rehabilitation
Explain the role of physical activity and the cycle of inactivity
e.g. using behaviour change techniques
Record findings of COPD review in patient’s medical records
e.g. which computer system used, any other methods used
