Preventing Hospital Admissions in Long-term Care Patients with COPD

By Matthew Barbour, Ohio Northern University, PharmD Candidate
A growing trend in healthcare is the focus on reducing hospital readmission rates among patients with certain disease states. One of these disease states is COPD. First time admissions and readmissions for patients with COPD have a huge impact on patient quality of life and healthcare expenses, so it is important to understand why admissions occur and how we as patient care providers can help prevent these admissions. A study of patients with Medicare and a diagnosis of COPD has shown that the two most common causes of readmission are COPD itself and pneumonia. By focusing on controlling a patient’s COPD and preventing pneumonia infections we can help to reduce admission rates among out long-term care patients.
One of the most important factors in controlling COPD is proper inhaler technique. Many new inhalers have recently come onto the market and it is important to learn how to properly use these new products before administering them to patients. Remember just because two different inhalers look similar does not always mean they work the same way. If you are ever unsure of how an inhaler works, double check. Even if the patient is inhaling with good technique, if the inhaler was not activated properly the patient will not get the medication they need. Assure with any inhaler the patient is following proper breathing technique: 
  1. Breathe out gently away from the mouthpiece. 
  2. Place mouthpiece into mouth and breathe in steadily and deeply. 
  3. Hold breath for 10 seconds or as long as comfortable for the patient. 
  4. Breathe out gently away from the mouthpiece. 
  5. Wait one minute between “puffs” for multiple inhalations of the same medication
  6. Wait one to two minutes before administering the next inhaled medication.
  7. Short-acting beta agonists should be administered before other medications to help open the airways for better medication distribution.
If patients appear to be having difficulty with their inhaler be sure to document it, this may be a sign that they need a different type of product that is easier for them to use, such as nebulizer treatments.
Incorporating evidence-based guidelines into your plan of care can help ensure appropriate assessment and adequate treatment is in place. In early 2015, the Global Initiative for Chronic Obstructive Lung Disease updated their recommendations for the diagnosis, management, and prevention of COPD (aka GOLD Guidelines). This document is available at http://goo.gl/Z2hihT
Flu and pneumonia vaccinations are extremely important in helping to prevent respiratory infections in patients with COPD. It is recommended that everyone 6 months or older who is able to should receive a flu vaccine every year. This is especially important in COPD patients as they are at higher risk of respiratory infections already due to their lung disease. A flu infection also puts patients at higher risk of getting pneumonia, so by preventing the flu we can prevent one cause of pneumonia. By using pneumonia vaccines we can help to further prevent pneumonia infections. Although not all care providers will be involved in the decision to vaccinate a patient there are steps that we can all take to help prevent the spread of infections such as using good hand hygiene techniques whenever entering or exiting a patient’s room and by using extra precautions, like face masks and gloves, when caring for those who are already sick.
 
References:
Decramer M, August AG, Bourbeua J, et al. Global Initiative for Chronic Obstructive Lung Disease: Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. Updated 2015.
Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the medicare fee-for-service program. N Engl J Med. 2009;360:1418-1428.
Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. CID. 2007:44;s27-s72