Sheraton 2-12-2006
Welkom
www.bvpv-sbip.be
[email protected]
Oprichtingsvergadering Brussel december 2003
Doelstellingen van BVPV-SBIP • Organiseren van permanente vorming in functie van de opleidingsbehoeften • Informatie- uitwisseling tussen zorgverleners en uniformiteit nastreven samen met de pneumologen. • Verpleegkundig wetenschappelijk onderzoek stimuleren • Uitbouwen en onderhouden van contacten met alle verpleegkundige verenigingen in binnen- en buitenland • Promoten van kwaliteitsnormen en de behartiging van de beroepsbelangen van de leden.
Leden • Lidmaatschap 10 euro / jaar • Jaarlijks congres / eerste zaterdag van december • Website : www.bvpv-sbip.be • Aansluiting bij internationaal netwerk www.nursearena.net • Korting inhalatieboek voor zorgverleners
Werkgroepleden
Nederlandstalige Franstalige
Eerste vpk congres : Inhalatietherapie december 2004 Genval
Evidence based tekstboek • Cathy Lodewijckx, UZ Leuven • Daniel Schuermans, VU Brussel • Actieve werkgroep BVPV : literatuur – expertise • Artsen: reviewing Prof. Decramer, Diensthoofd Pneumologie, UZ Leuven Prof. Dejongh, Longfysioloog, Medisch Spectrum Twente Prof. Dekhuijzen, Diensthoofd Pneumologie, UMC Nijmegen Prof. Derom, Kliniekhoofd Pneumologie, UZ Gent Prof. Verleden, Kliniekhoofd Pneumologie, UZ Leuven Prof. Vincken, Diensthoofd Pneumologie, AZ VU Brussel
Belgische Evidence Based Richtlijn • Belgische richtlijn – uniformiteit in voorschrijfgedrag, toediening, educatie • Wetenschappelijk gefundeerd – betere inzichten – meer gebalanceerd gebruik van inhalatoren
Belgische Evidence Based Richtlijn • Geïnspireerd door klinische expertise
• Praktische richtlijn – overzicht huidige inhalatoren – educatie m.b.t. inhalatietoestel en inhalatiemedicatie
Inhoudstafel • Depositie van aërosolen in het respiratoir systeem • Dosisaërosolen • Voorzetkamer • Droogpoederinhalatoren • Verneveling • Lokale bijwerkingen • Educatie • Patiëntenfolders – evaluatiepapieren • Inhalatiemedicatie
Doelgroep?
Alle zorgverleners die in contact komen met inhalatietherapie
Hoe het boek aankopen / bestellen? Prijs: € 26
Leden: € 15
Rookstopcongres : december 2005 Oostende
Opleiding 2006: «Rookstop voor verpleegkundigen » (educatie-kit) • RIZIV en RDQ ( Research, Development & Quality) Tervurenlaan 211 1150 Brussel • 14/12/2006 van 14u tot 16u – 12/12/2006 (franstalige)
• inschrijven via
[email protected] of 02/7397914 • 2 verpleegkundige per ziekenhuis
Verslag ERS Munchen 2-5 sept 2006
4 onderzoeksprojecten
Clinical pathway for acute COPD exacerbations reduces hospital stay and readmission Geert Celis , ERS Munchen
Clinical pathway for acute COPD exacerbations reduces hospital stay and readmission G. Celis RN, C. Lodewijckx RN, A. Schoonis RN, M. Decramer MD, PhD Pneumology Division, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Belgium
Day 6
Day 7
Day 8
Day 9
Day 10
M.Pr. 32mg per os
M.Pr. 32mg per os
M.Pr. 32mg per os
M.Pr. 32mg per os
M.Pr. 32mg per os
M.Pr. 32mg per os
M.Pr. 32mg per os
M.Pr. 24mg per os
M.Pr. 24mg per os
M.Pr. 24mg per os
Duovent 4x4 puffs
Day 1
Duovent 4x4 puffs
Duovent 4x4 puffs
Duovent 4x3 puffs
Duovent 4x3 puffs
Duovent 4x3 puffs
Duovent 4x3 puffs
Duovent 4x2 puffs
Duovent 4x2 puffs
Duovent 4x2 puffs
Spirometry bedside
Spir. body plethysmogr and TL,CO. Quadriceps force Hand grip strength, PImax PEmax cycle ergometry
Identification for ambulatory
Observations
ABG without O2
Observations
Weight
CT- thorax
Weight
COPD
BACKGROUND
Medication
Day 2
Day 3
Day 4
Day 5
AB if necessary Investigations
O2 therapy
Spir. bedside
Spir. bedside
Spir. bedside
Spir. + Plethysmogr
Spir. bedside
RX thorax
Obser vations
Observations
Observations
RX thorax
BGW
Sputum
Weight
Observations
Observations
Weight
Bloodsamples
Weight
O2 --> Sat > 90%
O2 --> Sat > 90%
O2 --> Sat > 90%
O2 --> Sat > 90%
O2 --> Sat > 90%
O2 --> Sat > 90%
O2 --> Sat > 90%
O2 --> Sat > 90%
O2 --> Sat > 90%
O2 --> Sat > 90%
StcO2
StcO2
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StcO2
StcO2
StcO2
StcO2
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Dyspnea-score
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Dyspnea-score
Dyspnea-score
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Dyspnea-score
Dyspnea-score
Dyspnea-score
Dyspnea-score
knowledge assessment self care behaviour
Checklist discharge preparation
Medical history Prescription fysioth.
Discharge preparation
screening Outpatient rehabilitation or LVRS
Observations
Sputum
Team
Education
Observations
1
Pluridisciplinary
Pat. Activities
Spir. bedside
COPD checklist by MD
0
2
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14
Prescription investigations Nurse intake
Readmission interval during the first year after discharge
Dietician Hygiene
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PT/Rehab
PT/Rehab
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PT/Rehab
Pluridisciplinary
Inhalation medication
Inhalation medication
Diet
Inhalationmedication
Evaluation inhalation methods
Evaluation inhalation methods
Smoking cessation
Evaluation inhalationmethods Check discharge criteria
2 Check discharge criteria
161
Evaluation homesituation Contact Social worker
94
COPD patients have frequent hospital admissions and a longer hospital stay compared to other chronic illness. In 2000 we implemented a 10-day clinical pathway (CP) for acute COPD exacerbations. In May 2003 the duration was reduced to 8 days. The CP describes the tasks of the multidisciplinary team: medication, examinations, diet, physiotherapy, education among lifestyle modification and therapy, nursing care and discharge management. The aim of the CP is to standardise the treatment, to reduce the length of stay and to screen patients for a rehabilitation program.
Mean HOSPITAL STAY
1
Critical Pathway displayed by day Medical Doctor (MD) and Respiratory nurse tick the activities to be performed. M.Pr. : Methylprednisolone; StcO2: Transcutaneous oxygen saturation; PT/Rehab : Physiotherapy or Rehabilitation; ABG : Arterial blood gases; LVRS : Lung volume reduction surgery 0
20
40
60
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100
120
140
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180
Reeks1
AIMS OF THE STUDY RESULTS To explore the benefit of a clinical pathway: • on the hospital stay • and the readmission interval in patients hospitalized due a COPD exacerbation.
METHODS A retrospective study. 68 CP patients and 94 control patients hospitalized due an COPD exacerbation during the year 2004.
The mean hospital stay for CP patients was 10.24 days (SD+-3.940) and the control group had a mean hospital stay of 13.21 (SD+- 12.663)(P=0.034). During the first year after discharge 35.3% of the CP patients had a mean readmission interval of 161 days (SD +- 117.80) and 34% of the control group had a mean readmission interval of 94.38 days (SD+- 95.16)(p= 0.029).
CONCLUSIONS Patients hospitalized for an acute COPD exacerbation and involved in a clinical pathway have a significantly shorter duration of hospital stay and a significantly higher readmission interval during the first year after discharge.
COMPARISON OF CARBON MONOXIDE (CO) MONITORING TO URINE COTININE (COT) ANALYSIS TO DETECT TOBACCO USE IN LUNG TRANSPLANT RECIPIENTS
Annemie Schoonis, ERS Munchen
COMPARISON OF CARBON MONOXIDE (CO) MONITORING TO URINE COTININE (COT) ANALYSIS TO DETECT TOBACCO USE IN LUNG TRANSPLANT RECIPIENTS A. Schoonis RN, N. Cuvillier RN, C. Lodewijckx LN, B. Bouckaert MD, L. Dupont MD,PhD, D. Van Raemdonck MD,PhD, G. Verleden MD,PhD Pneumology Division, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Belgium
BACKGROUND End-stage smoking-related COPD is one of the major indications for lung transplantation. While almost all lung transplant patients claim that they have quit smoking, we suspect that a considerable amount of these former smokers continue smoking since there is evidence that smokers are likely to misrepresent their smoking status. Previous studies show that urine COT analysis is more accurate than CO monitoring to detect tobacco use.
The purpose of this study was to detect tobacco use in lung transplant recipients and to compare the efficacy of CO monitoring to urine COT analysis. Group 2 non-smokers before transplantation smokers before transplantation
Emphysema Alfa-1-AT Cystic fibrosis PPH Pulm. Fibrosis Bronchoectasia Eisenmenger Kartagener other
63 ( 42%)
1 86 (58%)
non-smokers 1 before
7 10 6 8 6
22
Group 1
Fig 1 Smoking behaviour before lungtransplantation (LTX)
1 1 smokers before
49
0
20
11 3 18 1 1 1 40
Fig 10 Cotinine test Fig 5 CO-monitoring
CONCLUSIONS
Fig 7 Follow-up consultation Fig 4 CO reference value
Fig 6 Group 2 : 5 LTX patients with a positive CO result
RESULTS
AIMS OF THE STUDY
N= 149
Fig 3 piCO Smokerlyser®
60
80
100
Fig 2 Smoking behaviour before LTX by disease
The urine cotinine analysis identified 15 smokers. All of them were former smokers. 10% (15/149) of all lung transplant recipients and 17.4% (15/86) of former smokers were cotinine positive. Only 2 out of 15 (13%) reported initially to be currently smoking. After confrontation of the cotinine positive patients with repeated positive cotinine test results, 9 of the 14 cotinine positive patients eventually also admitted to have been started smoking again after transplantation (fig 8) CO monitoring classified 19 (12.7%) lung transplant recipients as smokers : 10 light smokers (11-19 ppm) and 9 heavy smokers (25-58 ppm). Nine of them were cotinine negative. Only 4 out of 9 were former smokers, suggesting that CO monitoring didn’t classify these patients correctly. Out of 15 cotinine-positive patients, 5 (33%) were incorrectly classified as nonsmokers based on CO monitoring.
METHODS A single-center, observational study was performed in 149 lung transplant patients of whom 86 were former smokers. During follow-up consultation, all patients were questioned about their smoking history and their current smoking habits. Smoking habits were also evaluated by means of urine COT analysis and CO monitoring.
134
positive COT test non-smokers
15
Fig 9 Smoking behaviour after LTX
Fig 8 Group 1 : 15 patients with a positive COT test
Our study showed that 17.4% of formerly smoking lung transplant recipients continue to smoke. Only 13% of these patients reported themselves to be currently smoking. In our study, urine COT analysis seems to be more sensitive and specific when compared to CO monitoring to detect tobacco use. The positive predictive value of CO monitoring is too low (52%), making it not useful as a screening tool.
HYPOTHESIS Systematic monitoring of urine cotinine levels is warranted in the follow-up of lung transplant patients who have a prior history of smoking.
Smoking cessation during hospital stay: nursing action and answers. Cathy Lodewijckx, ERS Munchen
Smoking cessation during hospital stay: nursing actions and answers C. Lodewijckx LN, G. Celis RN, A. Schoonis RN, J. De Bent RN, M. Peys RN, V. Lemaigre Psychologist, L. Van Houdenhove Psychologist, K. Nackaerts MD,PhD Pneumology Division, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Belgium
BACKGROUND
RESULTS (3)**
Hospitalisation, especially for tobacco-related illness: increases perceived vulnerability and boost receptivity to smoking cessation interventions brings smokers in contact with health carers who can provide a smoking cessation message or AIMS To explore: intervention need of smoking cessations intervention on respiratory wards nurses’ perceptions among smoking cessation interventions efficacy of nurse-delivered smoking cessation interventions
RESULTS (1) Methods: multi-centre descriptive study Sample: n = 548 patients hospitalised on 12 Belgian respiratory wards between 17/10/05 – 31/10/05 Results: smokers: n = 117 (21,9%); ex-smokers: n = 261 (46,8%); never smokers: n = 170 (31,2%) 378 patients (68,7%) could use our help to quit smoking or stay abstinent 67,44% 70%
not willing to quit
60%
10% 0%
no answer
40%
40%
20%
willing to quit
45%
50%
30%
46,8%
50%
33,2%
35% 29%
31,2%quit smoking for 0-6 days
30%
all patients quit smoking for 7-30 days
24%21,9%
25%
18,6%
16,85%
20%
15,5%
15% 10%
men quit smoking for 1-6 months
6,13% 13,6% 5,36%
12,6%
6,4%
4,21%
5%
Smokers 0% smokers
quit smoking for 6women months-1 year quit smoking for >1 year
Revie w
• Rigotti et al. (2003): meta-analyses of 29 studies; any type of health care setting • Schultz et al. (2003): overview of 10 studies (6 RCT’s); nurse-delivered hospital based interventions
Results
• significantly increase of quitting with nursing
n=54 (14,5%)
intervention • more intensive intervention is not significantly more successful • patients seems to be more receptive for smoking cessation interventions during hospital stay
Fig. 2: Nurse-delivered Fig. 3: Nursing smoking cessation smoking congres cessation intervention 03/12/2005 Ostend Belgium n=199 (53,5%)
RESULTS (2)** Perceptions among smoking cessation interventions: hospitalisation is an ideal time for patients to quit smoking smoking cessation is an important part of the nursing role Mean reasons for NOT providing smoking cessation: patient-related: lack of motivation, privacy, condition nurse-related: lack of knowledge, lack of skills and confidence, lack of time Tobacco use among nurses: prevalence: 7% - 46% perception of smokers in nurses among smoking cessation intervention: ▪ less enthusiastic ▪ less confidence in skills and efficacy
Tabel 1: Effectiveness of nurse-delivered smoking cessation interventions
CONCLUSIONS
At least 25% of patients hospitalised on respiratory wards could use help in quitting smoking or staying abstinent Strong evidence for effectiveness of nurse-led smoking cessation intervention Nurses perceive smoking cessation as an important part of their role, but need more skills and knowledge
CHALLENGES
Integration of tobacco dependence treatment into standard nursing practice Nursing education among smoking cessation interventions Support for tobacco dependent nurses Support (financial, resources) from government and hospital management
Ex-smokers ex-smokers
never-smokers
Fig.1: Smoking status in 548 patients hospitalised on 12 respiratory Belgian wards (10 different hospitals)
** References available by the author:
[email protected]
Counselling for smoking cessation needed in one third of hospitalised respiratory patients Daniel Schuermans, ERS Munchen • Eerste enquête BVPV-SBIP
ERS Travel Grant 2006
Next year : Nursing assembly from COPD supported by BVPV-SBIP (ERS 2007 in Stockholm)
Munchen 5 sept 2006 Oprichting van een internationaal netwerk voor pneumologie verpleegkundigen Active REspiratory Nurse Area http://www.nursearena.net www.nursearena.net
Nursing communication platform (NCP) • Wat? webbased platform voor respiratoire verpleegkundige verenigingen. • Doel: samenwerking tss verpleegkundige respiratoire verenigingen wereldwijd
Global Nurse Network Nursing communication platform Prof. Antje Fink-Wagner Manager Professional Relations Respiratory Global Franchise Management, Medical Communications
Nursing Communication Platform
NAVORMINGSAVOND COPD: COPD: een zorgprogramma ‘in een zorgprogramma ‘in de lift’ met een de lift’ met een cruciale voor cruciale rolrol voor dede verpleegkundige verpleegkundige
Waar? UZ Leuven (zaal BMW 6) navormingsavond Wanneer? Woensdag 15 november 2006
woensdag 15 november 2006
Specialisatieopleiding Pneumologie in UZ Leuven vanaf 11 januari 2007 • 10 lesdagen • Van jan tot april 2007
• Inschrijven kan bij Mieke Peys , hoofdverpleegkundige E652 UZ Leuven • Tel 016/346520 •
[email protected]
Jaarcongres BVPV_SBIP Zuurstof: Beter Ademen ? L’Oxygène : Mieux Respirer ?
