At one point or another, most RTs have been approached by a physician and been asked, “What should I do when I discharge this COPD patient?” Aside from the obvious list of checking medications and ensuring their liter flow is titrated correctly, tell them you know exactly what to do.
Surely you’ll have read blood gas reports during the patient’s stay, maybe even pulled the gas itself. If the patient was intubated, arterial blood gasses (ABGs) were likely done on a daily basis. Now that it’s time to go home, what do you do with the information you have and what additional information do you need to gather in order to offer them gold-standard care?
That’s where those critical thinking skills come into play. You can almost see the smile on their faces and the pride in their eyes as the wheels in your head move into action.
A few questions you may ask yourself or the patient’s physician:
- Are they current smokers? If so, what have you provided them with in regards to smoking cessation programs in their area?
- Do they need assistance in managing CO2 levels? If so, do you send them home with a Trilogy for CO2 control or recommend home BiPAP therapy? What settings do you select?
- How is their nutrition? Do they need an analysis? What is their body fat and how many extra calories are they burning each day in their struggle to breathe?
- What is their tolerance for performing activities for daily living (ADLs)? Are they limited? If so, what are their living arrangements and what kind of help do they have at home? Do their living conditions perpetuate decline or is it an environment you are confident sending them home to?
- How is their emotional state? Are they stable and healthy or do they need medications to help them maintain a positive outlook? Are they able to function and take care of things or anxious and/or severely depressed?
- What other conditions do they have related to their COPD that hinder them from progressing physically, emotionally and mentally?
SEE ALSO: Preventing COPD Readmissions
Obtaining this information can feel overwhelming, especially when this is just one of several patients you see in a given day. What can you do to cover your bases, being confident they are receiving care not only today, but on a continual basis?
The Gold-Standard of Care
The answer is pulmonary rehabilitation (PR). Pulmonary Rehabilitation is a comprehensive program that includes physical, occupational and respiratory therapy, nutritional assessment and guidance, emotional and mental help from a licensed therapist, individual and group counseling and exercise in a controlled, monitored and safe environment.
In a rehab setting, all of this is followed by a physician and experts who specialize in this type of therapy, helping the patient set goals and make progress in making lifestyle modifications that will offer them the quality of life they need in order to thrive. A good pulmonary rehab program will include several aspects and help both you and the physician take care of your patient.
PR has been proven to decrease exacerbations, the number and length of hospital stays and readmission rates in patients that actively participate. The patient will gain extensive knowledge on how to manage their disease outside the hospital and in their own home. They will become their own best advocate, proactively taking care of themselves.
Pushing Limits, Breaking Through
Many patients are scared, worried, insecure and hesitant to do anything that pushes them to their limits; when you can’t breathe, nothing else matters. And they feel this way until they discover, through gentle prodding, that their limits can change.
Treating them through a comprehensive program offers the well-rounded, multidisciplinary approach they need to truly succeed. Through nutritional counsel and guidance, their diet will change, adjusting for whatever their own particular needs may be. Through emotional and mental counseling, they will overcome the hurdles of anxiety and depression that are holding them in their current state of mind. Through physical and occupational therapy, they will learn to perform tasks differently and strengthen their body, making their available oxygen much more efficient.
Through respiratory therapy, they will learn how to breathe correctly, work their respiratory equipment properly, take medications the right way at the right times, monitor their levels of breathlessness and recover quicker. And through a combination of lifestyle modifications, they will discover that the things they once thought they would never do again they can still do.
It is truly a life-changing experience for patients, and one that, as a healthcare provider, you want for them – it gives this patient population another shot at living their most fulfilling life.
So when you’re approached by that questioning physician, tell them to send the patient to the gold-standard of care: pulmonary rehab. And they’ll listen; you are the expert, after all.
Dawn Lesley Fielding, RCP, AE-C is a respiratory therapist, educator and pulmonary rehab clinical specialist at Intermountain Healthcare, Salt Lake City, founder of Chronic Lung Alliance and author of The COPD Solution, available December 2015.
