Telehome Monitoring to Support Patients with Chronic Obstructive Pulmonary Disease and Heart Failure
Summary
The learning goal included learning how to properly assess and manage patients with both heart failure (HF) and chronic pulmonary obstructive disease (COPD). The prevalence of COPD among those with HF ranges from 20% to 32% of individuals. Likewise, 20% of patients with COPD also have HF. Given the high prevalence of COPD and HF, there has been a call for integrated disease management between cardiologists and respirologists, a collaboration ideally facilitated through the use of a nurse.
Presently, the University of Ottawa Heart Institute (UOHI) offers a Telehome Monitoring program for patients with advanced HF. Although experts in cardiac care, there is a knowledge gap regarding how to appropriately manage those suffering from both HF and COPD. The importance of having a nurse expert at UOHI is to ensure guideline recommendations are being followed.
First, I aimed to increase my knowledge for how to perform a respiratory assessment and how to manage patients with COPD, both pharmacologically and via self-management strategies. I connected with The Ottawa Hospital COPD Outreach Team, in which a registered nurse follows-up with their referred patients to ensure they remain on their medications and are not experiencing any symptoms post-discharge.
Second, I aimed to increase my knowledge of how to manage patients with both COPD and HF by performing a comprehensive scoping review. A literature review was deemed to be better suited to the needs of the department, and this remains ongoing with our librarian.
Third, I aimed to increase my knowledge for how to develop an effective knowledge dissemination plan with regards to managing patients with both COPD and HF. UOHI is presently developing their own HF pathway tool. As a member of this team, I will advocate for the need to ensure the assessment and management of comorbidities, including COPD, are included in the pathway to reduce future readmissions.
Fourth, I increased my knowledge regarding what is currently being done through the Ottawa Model for Smoking Cessation within UOHI and TOH to screen those most likely to be affected by COPD by meeting with the advanced practice nurse of the program.
Outcomes
The client population that was affected as a result of the Fellowship included those diagnosed with both COPD and HF. The lack of collaboration and coordination between those with an expertise in COPD and those with an expertise in HF became clear due to the geographical barriers of where our clinics are located in Ottawa. By having the time dedicated to shadow the nurses at TOH COPD Outreach Program, our two departments now having a closer working relationship, in which we can collaborate on questions regarding each diagnoses. This, thereby, allows for improved care for patients diagnosed with both COPD and HF. The geographical barrier between the two departments, and the want to continue to improve our collaboration and coordination, has also provided the foundation for exploring the possible use of virtual case conferencing in the future for this client population.
Overall experience
Being able to participate in the RNAO ACPF was phenomenal and truly gave me the opportunity to gain a more in-depth understanding of how patients diagnosed with both COPD and HF are monitored once discharged from our acute care hospitals. Although there remains a need for expertise to care for the patient with both COPD and HF, this requires a multidisciplinary approach and is difficult to do when specialists are geographically in two different locations. Therefore, until appropriate resources are in place, including respirologists at UOHI, the current state of affairs may remain our best option. That being said, I am now aware of the resources available for our HF patient population who also suffer from COPD, including the COPD Outreach Team, TOH COPD Exacerbation Pathway, the Respiratory Rehabilitation program, and the importance of referring smokers to our Smoking Cessation counsellors. I am also now more comfortable with the medications that are available for this patient population, and the self-care management strategies that are recommended. It has also been strongly encouraged that I complete the CRE to gain a more in-depth understanding of how to manage the patient diagnosed with COPD, which I plan to complete. UOHI is dedicated to continuing to offer the best care to our patients, and we are therefore assessing the opportunity to offer virtual case conferencing to our patients in collaboration with TOH COPD Outreach Team. This would continue to allow our patients to receive the best care from nurse experts, while simultaneously allowing the patient to remain at home.
