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Discharge management and education in home oxygen therapy

Discharge management and education in home oxygen therapy. Cathy Lodewijckx RN, MSc , PhD cand University Hospitals Leuven, Belgium Catholic University Leuven, Belgium European Pathway Association Belgian Society for Respiratory Nurses. Conflict of interest disclosure.

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Discharge management and education in home oxygen therapy

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  1. Discharge management and education in home oxygen therapy Cathy Lodewijckx RN, MSc, PhD cand University Hospitals Leuven, Belgium Catholic University Leuven, Belgium European Pathway Association Belgian Society for Respiratory Nurses

  2. Conflict of interest disclosure I have the following, real or perceived conflicts of interest that relate to this presentation. - - - - I have no, real or perceived, conflicts of interest that relate to this presentation. The intent of this disclosure is not to prevent a speaker with a conflict of interest (any significant financial relationship a speaker has with manufacturers or providers of any commercial products or services relevant to the talk) from making a presentation, but rather to provide listeners with information on which they can make their own judgments. It remains for audience members to determine whether the speaker’s interests, or relationships may influence the presentation. The ERS does not view the existence of these interests or commitments as necessarily implying bias or decreasing the value of the speaker’s presentation. Drug or device advertisement is forbidden. .

  3. Content • Background • Non compliance in current home oxygen care • Challenges for future home oxygen therapy

  4. Background (1) • Goal: • PaO2 > 7.98 kPa or SaO2 > 90% • ↑↑ quality of life and survival • Broad application: • Chronic lung diseases e.g. COPD, cystic fibrosis • Cardiac diseases • Palliative care • … Kampelmacher, 2001; Lodewijckx, 2008; Mitrouska, 2006

  5. Critical issue: non compliance (1) • What? • Non compliance to medicalprescription • LTOT: ≥ 16 hours a day / continoustherapy COPD and LTOT: Compliance = 17 to 45% • Short term oxygentherapy Oxygenuseduring ADL = low • Increasingoxygenflow: Carbonarcosis • Non compliance to precautions: burns • Smoking • Incorrect manipulation Cullen, 2009; Cullen 2006; Edelman, 2008; Duck, 2004; Kampelmacher, 2001; Lodewijckx, 2008; Pfister, 1995; Smith, 2004

  6. Critical issue: non compliance (2) • Important Issue? • Insufficient effect of oxygentherapy Condition, ADL, Quality of life, Prognosis • Hazardouseffects Carbonarcosisorburns • Adequate home oxygentherapy: • Effectivetherapy • Safe administration of oxygen • comfortableadministration of oxygen

  7. Determinants (1) • Patients: • Insufficient knowledge Medical, practical, technical • Impact on daily living (type of oxygen source!) • Negative views and anxiety • Shame and fear for social stigma • Active smokers • Financial factors Cullen, 2009; Cullen 2006; Duck, 2004; Kampelmacher, 2001; Lodewijckx, 2008; Pfister, 1995; Smith, 2004

  8. Determinants (2) • Carers: Lack of education and knowledge Medical, practical, technical, patient impact • Lack of coordination between primary and secondary care • Poor discharge management • Insufficient follow-up => Changing care context: ↑↑ need home oxygen therapy • ↑↑ prevalence COPD • Aging population • Shift secondary care to primary care Cullen, 2009; Cullen 2006; Duck, 2004; Kampelmacher, 2001; Lodewijckx, 2008; Lodewijckx, 2009; Pfister, 1995; Smith, 2004

  9. Challenge 1: Patient education (1) • Who: Patient AND Family / home carer • When and who? • At hospital: medical doctor, nurse, physiotherapists Contact withhealth Care professionals • At Home: Pharmacist & Supplier, nurse & General practitioner • Content? • Medicalinformation • Practical information • Technicalinformation Cullen, 2009; Cullen 2006; Kampelmacher, 2001; Pfister, 1995; Smith, 2004

  10. Challenge 1: Patient education (2) Medical information (medical doctor, …) • Aim of oxygen therapy • Effects • Advantages • Possible disadvantages Technical information (supplier, …) • Correct use and maintenance of the oxygen source • Precautions • Contact information for questions and technical problems

  11. Challenge 1: Patient education (3) Practical information (medical doctor, nurse, …) • Medical prescription • Precautions • Use of oxygen source and equipment • Use of oxygen during transport, air travel and holiday • Smoking cessation • Financial aspects • Flow: ____ L/min • Daily use: Continously; only at night, only during exercise, if short of breath • Oxygen can be increased during exercise, if short of breath (No/Yes: untill ____ L/min)

  12. Challenge 1: Patient education (4) • How to educate? (1) Oralinformation; (2) Demonstrationon correct use of oxygensource and equipment; (3) Evaluation of understanding (checklist); (4) Writteninformation: Patientleaflet Cullen, 2009; Cullen 2006; Kampelmacher, 2001; Pfister, 1995

  13. Challenge 2: EB Practice & uniformity • What? Best practice; Uniformity • How? EBGuidelines; national, regional level (uniformity) • Development: Literaturereview & Experts & Congresses 2. Dessimination: National book; nationaljournals National professional organizations (lectures) 3. Implementation: • Localapplication in different settings • Organization tools (ie transmural care pathway) • Continous follow-up of processes, outcomes Lodewijckx, 2008; Van Haecht et al. 2006

  14. Challenge 3: Education of carers • Who? All carersinvolved in oxygentherapy • At hospital: medical doctor, nurse, physiotherapists • At Home: Pharmacist, Provider, General practitioner • Content?Medical, practical and technicalinformation • How? • Access to electronic databases, websites of (inter)nationalsocieties (search strategy) • Training by experts: nationalcourses – local!

  15. Challenge 4: Discharge management < coordination > • Informpatient and family at needfor home oxygentherapy • Medicalprescription of pulmonologist • Education: patient, family, home care staf (nursing home) • Arrangement of home oxygentherapy Contact withoxygensuppier: socialworker / family Home delivery: Pharmacist / supplier • Check onreadiness of oxygenequipment BEFORE discharge • Arrangeoxygentherapyduring transport ifnecessary

  16. Challenge 5: Follow-up • Re-evaluationbypulmonologistwithin 1-2 monthsafter start Effect of therapy: Clinicalcondition, arterialbloodgases Needforfurthertherapy / adjustment of therapy Correct use of oxygentherapy Motivation & compliance • Ongoing follow-up by GP and home care nurse Systematicalassessment: detectproblems; referpatients • Re-evaluationbypulmonologistevery 6 months / ↓ condition Compliance to prescription, motivation, effect Short-oxygentherapy: re-evaluation 3-4 monthsafter start Cullen, 2009; Cullen 2006; Edelman, 2008; Duck, 2004; Kampelmacher, 2001; Lodewijckx, 2008; Pfister, 1995; Smith, 2004 >>ADL, quality of life, readmission, suvival<<

  17. Challenge 6: Research • What do we need to know? • What & where is needforinterventions? • What are (cost)-effective and feasableinterventions? What is impact onoutcomes? => Gouvernment: sensibilisation; financial resources? • Indicators? • Actualprevalence / compliance in patients • Processoutcomes: actual performance of healthcarers • Patientoutcomes: clinical, service • Financial outcomes (cost-effectiveness) • Impact of specificinterventions: Education, follow-up

  18. Challenges for future Home oxygen therapy Safe, comfortable and effective Home oxygen therapy • Adequate patient & family education • EB Practice & uniformity: EB Guidelines: development, dessimination , local implementation (care pathways) • Adequate education of carers • Organization of care: • Discharge management • Follow-up • Research: need & effectiveness of interventions

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