Patient details

Surname…………………………. Forename………………………NHS number……………….D.O.B………… Community Respiratory Team

MANAGEMENT PLAN – COPD Exacerbation
Actual Problem……………………………………………………………………………….

Goals agreed with patient, family and nurse
Short Term: Long Term:
Exacerbation is managed appropriately
Patient learns to recognise signs and symptoms of an exacerbation. Patient learns to recognise triggers for exacerbations and avoid if possible.
Respiratory Nurse Intervention:

1. Obtain consent
Prior to interventions, ensure all proposed treatment and interventions are discussed and fully
understood

2. Assessment
Perform thorough respiratory history and clinical examination

Decide on where to manage care (1, 2)
Use the table in appendix 1, COPD NICE 2010 to assist in decision making, taking into consideration
patient preference (1)
If hospital admission is necessary then discuss with GP refer to Unplanned Care Direct (UCD),
ensure transport is arranged and that ambulance administers correct oxygen if indicated (2)
Home treatment plan:
Increase frequency of bronchodilator use (1) Consider bronchodilator via nebuliser if available (1) (always specifying driving gas) Send sputum sample for culture and sensitivity (C&S) Consider oral antibiotics if purulent sputum according to Antimicrobial Guidelines and Management of Common Infections in Primary Care, 12th Edition 2010 (1) Consider prednisolone 30mg daily for 7-14 days- for patients with significant increase in breathlessness unless contraindicated (1) COPD exacerbation – management plan V1.0 2011.11.22 Surname…………………………. Forename………………………NHS number……………….D.O.B………… Consider mucolytic therapy if experiencing difficulty expectorating (1) Non medical prescriber to prescribe treatments where appropriate Advise on duration of prescribed treatment (1) Inform regarding the possible adverse effects of prescribed medication, for example, steroids (1) Instigate smoking cessation advice /support if indicated
3. Patient information
Explain about frequency of home visits by respiratory nurse, support available and contact numbers in case of any changes to care plan Reassure and give advice regarding when/how to seek medical advice Ensure awareness of correct use of medication, including oxygen if appropriate and stopping steroids Ensure GP is informed of all contacts with written evidence and prescriptions administered within 24 hours of patient contact Review condition as clinically indicated, perform thorough respiratory assessments as indicated and monitor changes in condition Refer to appropriate allied health professionals for assessment if necessary, and support at home.
For example: Physiotherapist, Emergency Response Team (ERT)

5. Review
Review patient daily by home visit or telephone assessment as clinically indicated

Perform respiratory system assessment at each contact, documenting changes and Allied Health
Professionals (AHP’s) involved in care package
Review antibiotic treatment when sputum culture results become available (1)
Re-establish optimum maintenance therapy Re-assess social care needs, and refer if necessary to appropriate AHPs or agencies
6. Promoting independence
Offer relevant education to enable future early recognition of the signs and symptoms of an exacerbation (1) for example: Increased breathlessness Increased ventolin use Increased sputum production Change in colour/consistency of sputum Surname…………………………. Forename………………………NHS number……………….D.O.B………… Increased cough Reduced exercise tolerance
Explain and provide patient information leaflets:

1- COPD self management plan
Implement the COPD self management care plan
Appendix 1. NICE Clinical guideline 101 (2010)
Table 4. Factors to consider when deciding where to manage exacerbations

(particularly cardiac disease and insulin-dependent diabetes) SaO2 < 90% Care plan initiated by……………………………………………Signature……………………… Designation……………………………………………………….Date commenced .…./…./…. Review Date 1. NICE Clinical guideline 101 (2010) 2. COPD QIPP Pathway V0.1 (2010) 3. GOLD Standards Framework (2008)

Source: http://www.liverpoolcommunityhealth.nhs.uk/Downloads/SERVICES/ADULTS/CRT/Care%20Plan%20COPD.pdf