Since he entered VNSNY Hospice care for his chronic obstructive pulmonary disease (COPD), retired architect Wallace Berger, age 93, has not had to visit the hospital once—a fact that his wife, Merle, credits to “the attentive care of VNSNY and his physician.” To help ensure that patients like Mr. Berger are able to live comfortably at home, VNSNY Hospice has ramped up its COPD protocols, implementing new training and treatment guidelines aimed at improving hospice clinicians’ ability to manage troubling symptoms such as shortness of breath in a home hospice setting.
“The goal of the program is to provide patients with severe to end-stage COPD with timely support and resources, in order to improve their and their families’ quality of life,” explains Dr. Ritchell Dignam, Medical Director of VNSNY’s hospice program. In addition, notes Dr. Dignam, the new protocols will be helpful in reducing rehospitalization of COPD patients within 30 days of hospital discharge.
One goal of the COPD program, which is unique among New York-area hospice agencies, is to encourage individuals with end-stage COPD and their physicians to enter specialized hospice care sooner, rather than continue to cycle through the hospital. Key elements of the program include empowering VNSNY Hospice nurses to order consults with respiratory therapists directly; emphasizing the use of nebulizers, which provide a continuous flow of bronchodilation medication; and training all hospice team members in techniques for relieving COPD-related symptoms such as anxiety.
“This new program is increasing awareness across our interdisciplinary care teams of the need to work closely with patients with COPD to avoid exacerbations, and to address symptoms swiftly if they occur,” says VNSNY hospice and cardiopulmonary nurse practitioner Fran Dooley, who is spearheading the advanced training. Besides the more proactive use of respiratory therapists, adds Dooley, VNSNY Hospice teams are now focusing more intensively on ensuring that patients are familiar with assistive breathing equipment, including oxygen tanks and BIPAP or CPAP machines, and are routinely encouraging patients to utilize nebulizers in place of rescue inhalers, which can be more difficult to operate.
Trained nurses are also available 24/7 to make house calls if COPD-related shortness of breath should flare up, similar to the approach used in VNSNY Hospice’s highly successful heart failure program. “As with heart failure, the trajectory of COPD at the end of life is unpredictable,” notes Dooley. “Even something as basic as a cold can send a COPD patient to the hospital if it’s not managed aggressively. With this program, we’re making sure our teams have all the tools they need to keep COPD patients comfortable and anxiety-free.”