August 11, 2014

Establishing a Nurse-Led COPD Clinic

COPD is a medical term that stands for Chronic Obstructive Pulmonary Disease. The word “Chronic” means it won’t go away; the word “Obstructive’ means limiting airflow; the word “Pulmonary” means in the lungs; and the word “Disease” means an illness. Many people with COPD have a combination of emphysema, chronic bronchitis and asthma. You may also hear COPD referred to as COAD (Chronic Obstructive Airways Disease), COLD (Chronic Obstructive Lung Disease) or CAL (Chronic Airways Limitation). COPD cannot be cured or reversed, but it can be treated.

In late 2013, our general practice held a COPD Clinic over the course of two consecutive days. It was supervised and run by our Registered Nurse (RN) and supported by the GP. Patients selected from our database by the GP included, but were not limited to those with either a past history of smoking or a history of respiratory conditions.
The purpose of this clinic was to identify, evaluate and educate patients who had the potential to develop COPD in the future. We also included some diagnosed COPD patients to broaden the scope of the sample group. The nurse-lead clinic enabled the practice to focus on this chronic disease and cater specifically to patients with support and resources. The concept of a COPD Clinic also enabled the GP to gain a different perspective on how the patient could be managed. A combination of different resources was sourced and used including:

  • Lung health and breathlessness symptom checklist
  • COPD screening results (interactive)
  • Lifestyle behaviour assessment
  • Referral to Heart Lung Team (for further or ongoing management)
  • Lung Foundation resources
  • Quit smoking
  • Radiology referrals
  • Patient evaluation form

Patients were telephoned and invited to participate in the clinic. At this time, the purpose of the clinic was explained and the available appointments filled quickly. During the clinic, a patient assessment was completed and the need for any additional tests identified. A follow-up appointment was scheduled one week later to allow the patient sufficient time to undertake any tests authorised by the GP. Patients said that they didn’t feel inconvenienced by having to return to see the GP and thought that the COPD Clinic was beneficial to the ongoing management of their health. All patients returned the following week with their test results.

In preparation for the follow-up appointment, the clinical team consisting of the RN and GP, evaluated each patient and drafted a management plan based on their findings. An outstanding feature of the clinic was the ability to be able to refer our patients on to the Respiratory Nurse Practitioner within the Heart Lung Team for further evaluation and lung function testing. This was organised with the Nurse Practitioner by the RN prior to the COPD Clinic. Other changes introduced to the patient’s care included, but were not limited to, referral to pulmonary rehabilitation and physiotherapy, medication review and quit smoking.

Feedback from the evaluation forms indicated patients would be inclined to visit another clinic in the future. They felt more informed about COPD and the need to improve their health. The clinical team did identify some problems and these were addressed with the patients. The reports received from the Heart Lung Team were invaluable to the ongoing management of the patient.

Our practice gained knowledge and experience with our first COPD Clinic and our patients benefitted from the experience and education they learnt along the way. We intend to run further clinics in the future and have just completed a cardiovascular disease High Risk Assessment Clinic in conjunction with the Medicare Local. We take this opportunity to thank Lung Foundation Australia for their assistance and support. Their resources proved invaluable both in patient education and as a practice reference.