Building the Adolescent Voice Part A. Breathing, Breathing, Breathing!
Breathing Plan - SMR Palliative Care Consortium of dyspnoea for use in the breathing plan Recognise...
Transcript of Breathing Plan - SMR Palliative Care Consortium of dyspnoea for use in the breathing plan Recognise...
Understand the project proposal and the best practice data available to assist in the development of the breathing plan
Identify the non-pharmacological and pharmacological management strategies for the symptom of dyspnoea for use in the breathing plan
Recognise the timely initiation of the breathing plan to effectively manage the symptom of dyspnoea
Learning Objectives
(American Thoracic Society 1999; Keenleyside and Ahmedzai 2008; Newton 2008; Booth, Bausewein et al. 2009; Dorman, Byrne et al. 2009; Palliative Care Expert Group 2010; Thomas, Bausewein et al. 2011).
Dyspnoea
Definition:
‘….a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity’
Project Proposal
Identify a need
Literature review
Audit of dyspnoea as a care plan issue
Audit of after-hours phone calls
Literature Review
Findings
Dyspnoea:
Common symptom
Not well understood
Poorly managed
Best Evidence Base
Strategies:
Pharmacological
Non pharmacological
o Self management tool
o Self manage exacerbations
o Instigate/prompt
o Improve patient wellbeing /activity
o Reduce carer anxiety and burden
Action Plan
Literature Review cont…
An audit process was undertaken:
To determine the number of clients currently registered with the palliative care service that presented at time of assessment with dyspnoea/breathlessness as a care plan issue
Calculate the percentage of palliative care clients that had contacted the after-hours phone service in the last 6 months with an exacerbation of breathlessness as the primary reason for contact
Audit Process
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10
20
30
40
50
60
70
80
Specialist Nurse 1 Specialist Nurse 2 Specialist Nurse 3 Specialist Nurse 4
No. clients
No. breathless as care plan issue
%
No clients: indicated breathlessness as a care plan issue
Clients experiencing breathlessness as care plan issue
Nurses undertaking assessments Number of Clients seen Number of clients that have indicated breathlessness as
a care plan issue
Percentage %
1 51 30 58.8
2 54 27 50
3 43 19 44.1
4 20 15 75
Total 168 91 54.154.1%
Month Total number of after-hours calls Number of calls primary reason
for breathlessness
Percentage %
September 56 6 10.7
October 47 3 6.3
November 55 3 5.4
December 54 1 1.8
January 62 3 4.8
February 60 7 11.6
TOTAL 334 23 6.8 %
Audit: after hours call outs
6.8%
Development of Breathing plan
Non pharmacological
Fan to face
Positioning
Distraction
Breathing techniques
Pharmacological
Opioids
Strongest evidence
Benzodiazepines
Helpful adjunct
Symptoms Medication WHEN WELL
No symptoms
Exercise as tolerated
Space activities and rest between
Continue with Preventer……………………………..
and bronchodilator inhaler………….………………..
medication if prescribed CAUTION
If you experience
Cough
Breathlessness
Pain
STEP UP TREATMENT
1. Position
Stand and lean hands onto wall or table or sit
leaning forward with arms resting on knees or
over the table on a pillow
2. Try to focus on an object/pet
3. Use a fan on face or stand in front of an open
window
4. Remain calm: Take slow relaxed breaths in
breath out with pursed lips
Continue to Use inhaler medication if prescribed
5. Take …………………………………….
as prescribed (opioid)
WAIT 10 MINUTES
EXTRA CAUTION
If NO improvement at anytime with the
above treatment then ...
Continue with slow relaxed breaths/focus 1. Repeat dose ……………………………………as
prescribed (opioid)
2. If Anxious: Take ………………………………as
prescribed (anti – anxiolytic)
IF NO IMPROVEMENT WIITHIN 10 - 15
MINUTES
Call RDNS 1300 33 44 55
DANGER GET HELP WHEN
Severe Shortness of Breath
Reliever medicine is not helping
Can only speak in short sentence
Feeling frightened
IF UNABLE TO CONTACT SERVICES
DO NOT WAIT
CALL 000 FOR AN AMBULANCE
Trial of the breathing plan: 6 month period
o All breathing plans instigated to be indicated in care plan for breathlessness
Evaluation of the project:
o Audit care plans and number using breathing plan
o Audit after hours calls with primary reason nominating breathlessness
o Distribute client and carer satisfaction surveys re use of breathing plan
o Final report to completed
Where to from here?
MARCH -> JUNE 2014 DECEMBER
2015
JANUARY -> JUNE 2015
LITERATURE REVIEW AND
AUDITS: AFTERHOURS/CARE
PLANS
EDUCATION OF
NURSING STAFF
TRIAL OF BREATHING PLAN
OVER SIX MONTH PERIOD
DEVELOPMENT
BREATHING PLAN
MAY -> JUNE
2014
JULY 2015 AUGUST 2015 SEPTEMBER 2015COMPLETE FINAL
REPORT BY END OF
DECEMBER 2015AUDITS: AFTER
HOURS/CARE PLANS
DISTRIBUTE AND COLLECT CLIENT SATISFACTION SURVEYS
Time Line
Dyspnoea
Debilitating symptom -> quality of life
Conclusion
Breathing Plan:
Optimally manage
Visual aid
Multiple strategies
Individualised
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References
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