Table 1 Details of Breathlessness Support Service
Time | Type of contact with clinic | Content of meeting |
|---|---|---|
Week 1 | First outpatient clinic visit | Contact with respiratory medicine |
· explore the symptom of breathlessness and its triggers | ||
· establish underlying cause of breathlessness | ||
· optimise disease-orientated management | ||
· review of previous investigations | ||
Contact with palliative medicine | ||
· experience of breathlessness | ||
· development of crises plan | ||
· burden on patient & family | ||
· symptom burden (other than breathlessness) | ||
· psychosocial & spiritual issues | ||
· introduction of non-pharmacological measures such as rollator and hand-held fan | ||
Week 2 – 3 Week 2 - 3 | Home visit Telephone call | Based on the patients’ needs as assessed during home visit: |
Physiotherapy input | ||
· review of the positions of breathlessness | ||
· provision of a walking aid | ||
· breathing control techniques and anxiety-panic cycle | ||
· management of exacerbations in COPD | ||
· home programme of exercise (DVD, personalised sheet) | ||
· cough minimisation techniques | ||
· pacing and fatigue management | ||
· sputum clearance techniques | ||
· ambulatory oxygen assessments | ||
· referral to pulmonary rehabilitation | ||
Occupational therapy input | ||
· assessment of ADL (mobility / transfers, self care and domestic ADL) | ||
· assessment for aids and minor adoptions and referral for provision of equipment | ||
· wheelchair prescription | ||
· education on planning, pacing and energy conservation techniques to patients and carers | ||
· referral to other community services (local / out of area), as appropriate | ||
· assessment of need for social support and liaison with the BSS social worker, as appropriate | ||
· liaison with the BSS team regarding interventions and feedback | ||
Social worker input | ||
patient and or carer assessment including understanding of disease and symptoms & information needs and coping strategies | ||
Week 4 - 5 | second clinic visit | Contact with palliative medicine |
· re-evaluation of breathlessness and other symptoms | ||
· checking of interventions | ||
· referral to medical and/or palliative care services if appropriate | ||
|  |  | · discharge from service |