Best Practices for COPD in Post-Acute Care

1. Understanding of COPD

In order to communicate effectively and empathize with patients regarding their disease, it is necessary for all caregivers of patients with COPD to appreciate the clinical limitations and ramifications associated with this disease. An overview of normal lung function and that of emphysema and chronic bronchitis is provided. Facts about the prevalence and impact of COPD are mentioned.

2. Assessment and Recognition of Signs and Symptoms

To provide the appropriate level of care and address the needs of the COPD patient, a complete assessment and review of key clinical information is important. Additionally, recognition of clinical cues, such as demonstration of signs and symptoms of exacerbation of the disease, should be recognized by all clinical personnel in post-acute care to reduce readmissions and ensure the safety of the patient.

3. COPD Exacerbation Risk Assessment and Plan of Care Development

The determination of COPD and its severity, as well as the risk for exacerbation, provides the clinician forewarning of potential adverse effects of the disease. Utilization of diagnostic testing and clinical assessments provides insight into the manifestation of the disease and exacerbation risk. Tools that assess this risk as well as current health of the patient are discussed. Additionally, the development of a plan of care and use of clinical practice and evidence-based guidelines is suggested.

4. Oxygen, Respiratory Equipment, and Medication Administration

In order to ensure that patients with COPD are utilizing the most appropriate therapeutic modalities to address their disease characteristics, it is important for the clinician to recognize, understand, and be able to demonstrate the use of various oxygen, respiratory, and medication devices and equipment. A review of the indications for and use of various treatment modalities is provided. It is suggested that a respiratory therapist or competency-verified nurse, trained in the use of these and other therapeutic modalities, be utilized in the care of patients with COPD.

5. Pulmonary Therapy

It has been shown that patients who participate in pulmonary rehabilitation have better outcomes and control of their disease. In the post-acute environment, individually designed programs of physical exercise, completion of activities of daily living, and disease- and care-specific education can improve patient self-confidence, emotional well-being, and physical conditioning. The components, goals, continuation, and clinical roles and expectations of staff for a program of pulmonary therapy are discussed.

6. Transitions-of-Care Tools

Transitions-of-care tools include program guides, workbooks, teach-back learning, action plans, and transfer and referral forms that can be used throughout the continuum of care. These tools, when combined with regular check-ins, are the basis for consistency of care and communication throughout the continuum of care. Using this approach prevents patients from being forgotten or overlooked and ensures reinforcement of best practices for COPD.