Download - Barnet Respiratory COPD Service
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Services provided by Central London Community Healthcare NHS Trust
www.clch.nhs.uk
Barnet Respiratory COPD
Service
Bunmi Adebajo
Clinical & Operational Service Lead
Clinical Specialist Respiratory Physiotherapist
Central London Healthcare NHS Trust
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Service context
Commissioned June 2011 by Barnet CCG to deliver
a COPD service with a high level of respiratory
specialism in a community setting.
Tasked with:
Providing high quality safe care with easy access to
services.
Equitable and fair access in management of the
patients
Delivering a good patient and carer experience
Responsive and patient-centred care
Contain costs
The CLCH environment
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Barnet
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Barnet COPD Service Remit
The overall aim of the Service is to improve the
quality of patient care, for those living with COPD
such as the management of complex COPD patients,
and patients in receipt of home oxygen, in a setting
close to, or within their homes.
The Service also offers advice and education
regarding COPD to primary care clinicians.
COPD is characterised by progressive airflow obstruction.
Airflow obstruction is defined as a reduced FEV1 as measured
by spirometry when less than 80% predicted and FEV1/FVC is
less than 0.7 (NICE)
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Barnet COPD Service Remit
This Service is part of an integrated COPD pathway across primary and
secondary care, working in partnership with GPs, Respiratory Consultants,
Specialist Nurses and Physiotherapists, Community Nursing and other
Health Care Professionals, in order to deliver community-based care.
Services provided :
• Assessment and management of acute exacerbations;
• Assessment and follow up of patients in receipt of home oxygen;
• Time limited case management;
• Community clinics;
• Pulmonary rehabilitation and maintenance programme;
• Patient support for self management;
• Education and support in primary care.
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Barnet COPD Service Remit
Contact Details
Tel No: 02083497539
Fax No: 0300 0083159
E-mail: [email protected]
Patient Advice Line Tel No:
07943828371
Respiratory
Consultant
Review
Acute
Exacerbation
Rapid Access Assessment &
Treatment
Respiratory
Nurse Specialist
Review
Hospital at HomeCOPD exacerbations
Pulmonary
RehabilitationMRC dyspnoea2, 3 &4
Home Oxygen
Assessment &
Follow-up (Adults all
conditions)
(SaO2 <92%)
COPD
Community
ClinicsReferrals
BarnetCommunity COPD Service
The team
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Bunmi Adebajo
Clinical & operational service lead
Temi Magbagbeola
Lead Respiratory Specialist Nurse
Sheila Morris
Geraldine Kerr
Tsitsi Mazivanhanga
Philani Myenyiwa
Senior Respiratory Nurses
Annette Glencross
Michelle Banks
Christy Wabara
Respiratory Nurses
Kola Akinlabi
Lead Respiratory physiotherapist clinical specialist
Binny Patel
Ken Johnston
Senior respiratory physiotherapists
Rado Trojak
Physiotherapy assistant
Maureen Greenwood
Kim Tinneny
Service administrators
GP COPD Team Community
ClinicReferral for sent to:Fax: 0208 349 7353
E-mail: [email protected]
Triage by Senior
Clinician
Not Accepted
Direct ReferralsInform referrer
RMS ReferralsReturn to RMSAllocate to Clinic:
Location, Date, Type, (Consultant, nurse, HV)(Document in referral book)
Admin books patient on SystmOne & sends
appointment letter to patient
Patient seen in clinic by clinician
GP letter & Outcome out onto clinic list
Community COPD Clinic
Clinic Home Visit
Social Services
Home O2
Follow-upDietician Palliative
CarePulmonary
RehabCase
Management
Self (If Known to Service)
A&E(Not Admitted)
Referral
Community COPD Clinic
Follow up & Referrals
Admin Outcomes patient on
SystmOne & type letters and send to
GP once signed by clinician
Admin puts clinic FU appointment on
SystmOne & sends letter to patient
Barnet COPD Referral Pathway
Out patient community
respiratory Clinics• Respiratory
consultant clinics
• Nursing & Allied
Health professional
clinics
• Edgware & Finchley
Memorial hospitals
• New patients & follow
up reviews
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Domiciliary home visits & Hospital @ home service
Domiciliary visits for
IECOPD & routine
planned care
Nursing & physiotherapy
professionals
Patient advice line
support
Patient self referral*
alongside health care
professional referral
CRP FBC Sputu
m
ECG
Initial Assessment to determine further investigations (if any)
Monitoring
Confirm COPD Exacerbation
Worsening of symptoms with increased
breathlessness, increased sputum, purulent sputum
First Visit Assessment
History taking & physical assessment
Exclude other respiratory differential diagnosis
Observation: SpO2, Pulse, BP, RR, Temp
Baseline BORG, CAT, and HAD
Investigation
ABG’sCXR
Implementation of COPD Treatment Plan
(Normally maximum of 5 visits in 14 days is required)
Medication Treatment
COPD Exacerbation Pathway
Pulmonary Rehabilitation Service
• Three locations within
the borough
• Rolling programme all
year round
• Physiotherapy lead
multidiscipline
delivery
• Programme run as seven
weeks of exercise
rehabilitation & education
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Spirometry
• Delivered at Edgware
& Finchley Memorial
hospital
• Weekly delivery
• Currently
commissioned for
testing only and
limited annual
caseload
• GP referral.
Barnet HOS-ARHome oxygen assessment review service
Barnet Community COPD Service Referral Form
Service contact details
• E-mail: [email protected] (preferred referral
route). Hospital @ home referrals must have a
telephone call made at time of referral.
• Post: Barnet Respiratory COPD Office, 2nd Floor
Westgate House, Edgware Community Hospital, Burnt
Oak Broadway, HA8 0AD
• Office Land line: 02083497539
• Service E-Fax No: 0300 0083159
• Patient Advice Line No: 0794382837117
The future
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Questions
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