You are on page 1of 7

CHRONIC OBSTRUCTIVE PULMONARY DISEASE CLINICAL PATHWAY

QEH/HH PCH KCMH Souris Western Stewart Memorial O'Leary PATIENT ID

INCLUSION CRITERIA All patients who are admitted to hospital and diagnosed with Chronic Obstructive Pulmonary Disease (COPD). EXCLUSION CRITERIA Patients under 18 years of age Patients diagnosed with Febrile Neutropenia or admitted to Critical Care.

HOW TO USE THE CLINICAL PATHWAY


1. This is a proactive tool to avoid delays in treatment and discharge. These are not orders, only a guide to usual orders. 2. Place the Clinical Pathway in the nurses clinical area of the chart. All health care professionals should fill in the master signature sheet at the front of the Pathway. Addressograph/sticker each page of the Pathway. 3 HEALTH CARE PROFESSIONALS: Initial tasks as completed. Bulleted and shaded sections do not need to be signed for on the pathway, but are to serve as a remider for consideration and to be completed as required. Additional tasks due to patient individuality can be added to the pathway in OTHER boxes and/or Progress Notes. 4 PATIENT TRANSFERS: If patient is transferred to another hospital in PEI or to home care or long-term care facility, send a copy of the following to the receiving site/agency: Discharge Criteria - Original to stay on patient chart Teaching Checklist - Copy with patient in education packet - Original to stay on patient chart

Updated April 20, 2011

Adapted from Grey Bruce Health Network

Review November 1, 2011

NAME (Please Print)

INITIAL

SIGNATURE

TITLE

Updated April 20, 2011

Adapted from Grey Bruce Health Network

Review November 1, 2011

CHRONIC OBSTRUCTIVE PULMONARY DISEASE CLINICAL PATHWAY


COMORBID CONDITIONS:

Admitting Date / Time _______________________

PATIENT ID

PHASE 1
PROCESS (Approximately 2 days)
ADMITTING VITALS DATE MET INITIAL

DATE
____________ evening night day night

DATE
____________ evening day

Respiratory rate < admitting rate Heart rate < admitting rate

PATIENT OUTCOMES

Temperature < admitting rate Dyspnea scale score < admitting rate Saturations achieved with less oxygen (flow or %) VS Q4H & PRN X 24H, including SpO 2 VS QID X 24H, including SpO 2 Chest assessment Q4H (breath sounds, productive cough)

Once all Patient Outcomes are achieved, move to Phase 2

ASSESSMENT (OBSERVATIONS/ MEASUREMENTS/ ELIMINATION)

Dyspnea scale with activity Dyspnea scale at rest Monitor intake / output Mental status (time, place, person) Isolation: Droplet / Contact Precautions (if necessary) - Pneumococcal Immunization History: - Influenza

Yes Yes Yes

No No No

Unknown Unknown

CONSULTS

Contact Physio Re: Breathing Exercises

Instructions for Dyspnea Scale:


For Patients: "This is a scale that asks you to rate the difficulty of your breathing. It starts at 0 where your breathing is causing you no difficulty at all and progresses through to number 10 where your breathing difficulty is maximal. How much difficulty is your breathing causing you right now?" 0 0.5 1 2 3 4 Nothing at all Very, very slight breathlessness Very slight breathlessness Slight breathlessness Moderate breathlessness Somewhat severe 5 6 7 8 9 10 Very, very severe breathlessness Maximal breathlessness Severe breathlessness Very severe breathlessness

Updated April 20, 2011

Adapted from Grey Bruce Health Network

Review November 1, 2011

CHRONIC OBSTRUCTIVE PULMONARY DISEASE PHASE 1


PROCESS (Approximately 2 days)

PATIENT ID

DATE
____________ evening night day night

DATE
____________ evening day

ADMISSION - ACUTE
Bedside spirometry, if ordered Sputum for C&S if ordered CXR, PA & lateral

Yes Yes Yes

No No No

N/A

DIAGNOSTICS/ LABORATORY

ABGs ECG if ordered ECG with chest pain, notify physician Blood work as ordered Blood culture X2 if ordered Intermittent set / IV as ordered, reassess day 2

MEDICATIONS TREATMENTS/ INTERVENTIONS NUTRITION MOBILITY/ACTIVITY PSYCHOSOCIAL SUPPORT/ EDUCATION

Assess proper use of inhalers Medication Reconciliation Oxygen to keep SpO 2 88-92 or as ordered Assist personal hygeine Regular diet or special diet ____________________________, Encourage fluids 2-3 litres/day BRPs with assistance, increase to AAT Walk in hallway Review Patient Pathway Start Teaching Checklist Assess anxiety and intervene Assess Discharge Criteria daily <4 day hospital stay

Yes

No

DISCHARGE PLANNING

Assess for additional supports:

>70 years old Unstable secondary DX Social situation Medication compliance

Other:

Updated April 20, 2011

Adapted from Grey Bruce Health Network

Review November 1, 2011

CHRONIC OBSTRUCTIVE PULMONARY DISEASE CLINICAL PATHWAY PHASE 2


PROCESS (Approximately 3 days)
DATE MET INITIAL

PATIENT ID

DATE
___________ evening night day night

DATE
___________ evening day night

DATE
___________ evening day

Off supplemental oxygen or on usual O2 if on chronic home oxygen Activity level as per preadmission

PATIENT OUTCOMES

Usual mental status Temp less than 38 c Dyspnea scale score improving On PO meds X 24 hours Understands diagnosis and discharge plan VS BID once stable, including SpO 2 Chest assessement Q4H (Breath sounds, Productive cough) Dyspnea scale with activity Dyspnea scale at rest Mental status (time, place, person) Monitor intake / output Isolation: Droplet / Contact Precautions (if necessary) Smoking cessation referral made, if necessary

Once all Patient Outcomes are achieved, move to Discharge Criteria

ASSESSMENT (OBSERVATIONS/ MEASUREMENTS/ ELIMINATION)

CONSULTS
Home O2 therapy referral, as needed Repeat CXR if patient is not improving from Phase 1 Blood work as ordered ABGS if new home O 2 patient Re-assess patient's proper use of inhalers

Yes Yes Yes

No No No

N/A N/A N/A

DIAGNOSTICS/ LABORATORY

MEDICATIONS

Review discharge medications Intermittent set / IV as ordered

Yes

No

Updated April 20, 2011

Adapted from Grey Bruce Health

Review November 1, 2011

CHRONIC OBSTRUCTIVE PULMONARY DISEASE PHASE 2


PROCESS (Approximately 3 days)

PATIENT ID

DATE
___________ evening night day night

DATE
___________ evening day night

DATE
___________ evening day

MAINTENANCE
O2 if indicated - discontinue if SpO 2 in ordered range at rest and with activity

TREATMENTS/ INTERVENTIONS

Physio: Breathing Exercises Assist with personal hygeine ,as necessary Regular diet, or special diet __________ encourage fluids 2-3 litres/day

Yes

No Date:____________

NUTRITION
If tolerating diet, encourage snacks to meet increased nutritional needs from illness

MOBILITY/ACTIVITY PSYCHOSOCIAL SUPPORT/ EDUCATION

Increase activity as tolerated Review Patient Pathway Continue Teaching Checklist Review handouts Assess patient knowledge Assess Discharge Criteria daily

DISCHARGE PLANNING

Equipment and supports arranged Book follow-up appointment post-discharge Review discharge plans with patient

Yes Yes Yes

No No No

N/A N/A N/A

Updated April 20, 2011

Adapted from Grey Bruce Health

Review November 1, 2011

CHRONIC OBSTRUCTIVE PULMONARY DISEASE CLINICAL PATHWAY


PROCESS
PATIENT ID

DISCHARGE CRITERIA
Decreased sputum production and purulence from onset Resp <24/MIN for 12-24 hours

DATE

INITIAL

N/A

ASSESSMENT (OBSERVATIONS/ MEASUREMENTS/ ELIMINATION)

Temp <38 for 12-24 hours Pulse <100 BPM for 12-24 hours Dyspnea scale normal for patient Usual mental status SpO2 >90% or as ordered - within patient's norm Follow up chest x-ray

CONSULTS DIAGNOSTICS/ LABORATORY

Smoking cessation referral made, if necessary Stable comorbid illness Spirometry if ordered Patient demonstrates accurate use of metered dose inhaler Inhaled beta 2 agonist therapy required no more than Q4H

MEDICATIONS

No antipyretics for 24 hours Determine if patient is able to pay for necessary medications post-discharge Discharge medication list reviewed and copy to patient

TREATMENTS/ INTERVENTIONS NUTRITION MOBILITY/ACTIVITY PSYCHOSOCIAL SUPPORT/ EDUCATION DISCHARGE PLANNING

Influenza vaccine (Follow-up if appropriate) Pneumococcal vaccine (Follow-up if appropriate) Tolerating diet as ordered Patient's normal activity Education materials and Patient Pathway home with patient Teaching Checklist complete Patient questions answered Home care if necessary Follow up appointment within 2 weeks of discharge

Updated April 20, 2011

Adapted from Grey Bruce Health Network

Review November 1, 2011