Pulmonary Rehabilitation Program - Essay Example

Ruing Head: Pulmonary Rehabilitation Program A Rationale for Inclusion of a Pulmonary Rehabilitation Program Name: Course: Tutor: Introduction So many Respiratory therapy methods have been developed to help patients with pulmonary diseases and enable them live a quality life. One of such methods is respiratory rehabilitation programs. This program was found effective in treatment of COPD and has been increasingly recommended by governments for treatment of pulmonary diseases (Hui & Hewitt, 2003) The method has been found to reduce health care cost as compared to other respiratory therapies. The inclusion of such a program in a hospital department and the type of program developed however depend on several factors. These include; the national guidelines for creation of a pulmonary rehabilitation program, availability of resources in the hospital and the region of the hospital and the type of patients that the hospital receives. Hospitals therefore develop different programs based on the above factors. In this paper, the rationale for including a pulmonary rehabilitation program in a hospital’s pulmonary and critical care department will be discussed. This will be based on the hospital’s available resources, the requirements of the national guidelines and the clinical guidelines considering the program structure, exercise training programs, patient assessment, staff members and staff sessions, models of delivery of the program, the equipments used in the program, the involvement of patient family members, how continuity is achieved after patient discharge, the hospital’s department aims, how the program teams work, how the rehabilitation intervention is delivered and type of patients that visits the hospital. The aim is to describe the important reasons for including a pulmonary rehabilitation program in a hospital. The hospital covered in this case is John Hospital in London. Rationale for inclusion of a Pulmonary Rehabilitation Program in John Hospital Rehabilitation Program Respiratory therapy methods have been found to be labor intensive and very costly. Several methods of making sure those patients have quality life have since been developed (Stein, 1998). Pulmonary rehabilitation has been found to be the appropriate method of treatment of lung diseases. It has shown increase in physical activity, in endurance, in exercise tolerance and decrease in psychosocial dysfunction and breathlessness among patients with pulmonary diseases (Fishman, 1996). John Hospital has a pulmonary rehabilitation program that incorporates an interdisciplinary model. This considers the patients of pulmonary diseases as well as their families in the therapy. The aim of any pulmonary rehabilitation program is to ensure maximal independence and function in the community. John’s Hospital is not an exception. The hospital’s department of pulmonary and Critical Care Medicine has a pulmonary rehabilitation program that aims to reduce or eliminate dependence on mechanical ventilation and to improve the capacity of daily living activities and exercise on pulmonary disease patients (Fishman,1996). Considering the hospital resources, the availability of professional staff is a challenge. When professional staff is not enough and there is need to establish a pulmonary rehabilitation program, the available professionals are used with a suitable model. In this case, the few staff members are made to work in different sessions while working in different areas when not in program session. The structure and model of delivery of the pulmonary rehabilitation program supports the situation in John Hospital. John hospital has an interdisciplinary team for program service delivery. The few staff members work on rotational basis with only one member as the core member of the interdisciplinary team. The rest are extended members with consultants being invited only when there is need. Due to the complexity of pulmonary diseases and different requirements, different professionals are required for different functions. The program has different professionals who offer the services daily, those that can be invited for specific reasons for example consultation and those that are just extended members who work when needed. This means that not all the team members are available all the time. The Pulmonary and critical care department has developed a system where the program has specific times for specific staff members to work. Program sessions also take only one –two hour sessions so that extended members have the time to conduct other duties (Fishman, 1996). Another challenge is space in the hospital. Due to the unavailability of space for inpatient admissions and the high number of other patients who require admission, the hospital opted for an outpatient pulmonary rehabilitation program. Outpatient pulmonary rehabilitation program also help reduce the expenses due admission both for the government and the individual patients’ families. The hospital’s pulmonary rehabilitation program has a complete phase 11 outpatient rehabilitation program with the required components of a pulmonary rehabilitation program and a maintenance phase known as phase three rehabilitation program for follow up process (Aacvpr, 2004). There are 4 basic components of a pulmonary rehabilitation program. These are; initial patient assessment which should ensure medical therapies have occurred to qualify a patient to be enrolled for the program. There must be a program of exercise training to increase peripheral muscle strength and muscle endurance. Strategies that lead to improved patient health status and quality of life should be implemented. Functional training must also be available in order to reduce functional limitations. The program has to have a team that will ensure delivery of the program and the team members have to be competent in various areas according to the clinical competency guidelines for pulmonary rehabilitation programs. Patients who suffer psychosocial symptoms should be helped and so strategies for identifying and minimizing such should be developed. Pulmonary rehabilitation intervention also requires participation of the patients and their families therefore should have an educational component (Garrod, 2003). Components of John Hospital’s Pulmonary Rehabilitation Program John Hospital’s pulmonary rehabilitation program consists of the following basic components. Patient evaluation (which entails diagnostic testing, physical and psychosocial evaluation), psychosocial support, Chest physiotherapy, exercise training and an educational component (Parsons & Heffner, 2001). All these components are delivered by the hospital’s rehabilitation team which is interdisciplinary. Patient Assessment No patient is admitted to the program without a referral from a qualified physician or health professionals. Qualified health professionals that always refer a patient for admission to a pulmonary rehabilitation program I the hospital include pulmonary rehabilitation specialized nurses, physiotherapists, pulmonary rehabilitation consultants and respiratory therapists (Barnett & Wells). After admission, admission patients are always subjected to required tests to qualify one to participate in the program for example exercise stress test among others. Patients with COPD for example have to be assessed for oxygen saturation, have to have their chest X-rays checked, have to complete the quality of life and depression questionnaires and have to undergo the shuttle walk test. These reveal what each patient require if he/she qualifies for admission into the program (Barnett & Wells). This is done based on the exercise capacity and functional abilities of the patient. The patient is also assessed of psychosocial symptoms (Aacvpr, 2004). Post Rehabilitation Program (Phase 111) After completion of the formal sessions of a pulmonary rehabilitation program, patients are followed up to ensure success of the therapy. Follow up could be done through letters or emails with reminders of what the previous patient should do. This may not be efficient as it depends on the patient dedication and satisfaction. However, maintenance programs developed by health care institutions that offer this program help patients maintain their improved status achieved from phase 11 of pulmonary rehabilitation program (Parsons & Heffner, 2001). These programs are based on how to achieve long term exercise training. John Hospital has a program that provides information to patients on areas where long term exercise training can be achieved and also has a center where the facilities are available for graduates of the program (Aacvpr, 2004). Follow up procedures are also conducted after six months to evaluate the patients’ status. Patients are normally reassessed for readmission when necessary or confirmed in good health after the reassessement. A maintenance program and a follow up process reduce wastage of already utilized resources. If the patients are not followed up, the efforts of the program services would be useless (Parsons & Heffner, 2001). How the Delivery is achieved Specialized nurses on pulmonary rehabilitation conduct initial interviews to any patient admitted to the program. This interview evaluates the educational needs and the exercise needs of a patient. Each patient therefore has specific requirements and is treated under the rehabilitation program based on the specific needs (Nici et al, 2007). The hospital has a rehabilitation center with exercise facilities where the exercise sessions are always conducted. The exercise equipments include free weights, treadmills and stationary bicycles among others. These equipments are meant to improve a patient’s stamina and strength. Exercise Sessions These are dependent on patient requirements and the type of pulmonary condition. There are those that are performed daily for a specific period of time and there are those that are done weekly. Training methods of exercise help achieve the aims of improving patient quality of life. Methods such as strength, cardiovascular, neuromuscular and range of motion help the patient in various ways. Cardiovascular training method for example is meant to develop efficient breathing patterns in a patient as well as increase ventilatory threshold among other purposes (Ehrman et al, 2008). All these are in the exercise program to help achieve the benefits of pulmonary rehabilitation program in the hospital. Examples of exercises used are, cycling, walking, lifting of free weights, use of iso-kinetic and isotonic machines, breathing exercises, stretching and walking balance exercises. The hospital however does not have the space for creation of a swimming facility although swimming is one of the exercises that patients should be offered. The hospital however has other exercises that perform the same function such as cycling and walking (Ehrman et al, 2008; Rennard, 2007). John Hospital’s pulmonary rehabilitation program ensures efficient communication of a patient’s progress to the patient’s physician and the hospital’s pulmonologist. Progress is measured by a comparison of the patient’s status on admission to the current state when a report is made. It is determined by the oxygen saturation levels, heart rate, blood pressure measured in each exercise session. The average period of a pulmonary rehabilitation program is 8 weeks with some extending to 12weeks. John Hospital pulmonary rehabilitation program takes an average period of 8 weeks but is sometimes extended due to patients’ different personal medical needs and physical needs (Ehrman et al, 2008). . Each program session takes one hour inclusive of the education component. Extra hours are allocated for counseling needs or other specific needs or fixed into the program hours depending on the patient availability and progress (Pauwels et al, 2004). Program respiratory therapists, dietitians, exercise therapists and other members provide educational classes to the patients and their families according to clinical guidelines of pulmonary rehabilitation programs. The topics discussed about are; the medication management, nutrition, relaxation and breathing techniques, panic control, how to manage emergencies cases, and stress management (Nici et al, 2007). The program is headed by a certified pulmonologist as the director and has other professionals. The team consists of 10 cardiac life support specialized nurses, 2 pharmacists, 2 dietitians, 3 respiratory therapists and 10 exercise physiologists. Consultants are hired whenever necessary in order to assist patients and their families and to educate the extended team members. When educating the team members, conferences are held while patients are handled according to specific needs. Decision making about a patient’s case is done through a team approach because of the kind of team model proposed for the program. Each member has his or her responsibility, conduct different assessments but come together in a conference to plan patients’ treatments, set goals and evaluate patients’ progress (Fishman, 1996). Family assistance mostly comes from the education offered by the respiratory therapists who builds some confidence in the patients and the family members and help them accept their problems due to the knowledge about the pulmonary disease conditions. This is already included in the program. Specific aims of the rehabilitation program include; increasing the ability of the patients to perform their everyday activities, reduction of shortness of breath, improvement of stamina and patient strength, improvement of the mental well being of the patient a well as the physical well being and decreasing depression. In order to achieve these aims, a program with the components that John Hospital has and components indicated by national guidelines to be suitable for a pulmonary program has to be implemented (Parsons & Heffner, 2001). Other Fundamental Reasons for Inclusion of a Pulmonary Rehabilitation Program Why would a program be developed or implemented in a hospital? In any health care institution, it would be for provision of quality health care and satisfaction of patients. According to research done by scientists, pulmonary rehabilitation programs have proved to be effective in most health care settings that they have been used. There are other respiratory therapies but the effectiveness of this kind of program has enabled its use and even its expansion for other pulmonary disorders in most hospitals. This explains one of the reasons why the pulmonary rehabilitation program has been included in John Hospital. London is a well established city with so many resources. Some of the important resources for pulmonary rehabilitation program include; the British Thoracic Society (BTS), National Service Framework, The British Lung Foundation and the funds made available for the program (BTS Statement, 2001; BTS COPD Consortium). The organizations provide support and information abut pulmonary rehabilitation programs and their importance to the society. They provide evidence of their need and even support to some hospitals. NHS funds assist some hospitals in London to set up the pulmonary rehabilitation programs (BTS COPD Consortium). Past experience on the cost of health care provided to COPD patients made the British government accept methods of treatment that would reduce health care cost (Garrod, 2003). The region has no National Service Framework for patients with respiratory disease, but the British Thoracic Society has shown a lot of support for the development of this kind of program. According to (Garrod, 2003), in 2003, the BTS highlighted urgent need for more rehabilitation services. 600, 000 lives of patients with respiratory diseases were at stake if rehabilitation programs were not implemented. Garrod also indicated that pulmonary rehabilitation could lead to financial benefits to the health care service (2003). With this kind of support, inclusion of this program in the hospital is so beneficial ot only to the patients but also to the government and BTS. The aim of John hospital’s Pulmonary and critical Disease Department is to provide solutions to the disorders and diseases and ensure patient satisfaction. The program provides solutions to pulmonary disease patients and therefore helps the department in achieving its goals. Patients of pulmonary rehabilitation program benefit from enhanced quality of life, reduced hospitalization and emergency room visits, reduced depression and anxiety, increased exercise capacity, reduced respiratory symptoms and improved ability to perform daily activities (Barnett & Wells). According to Aacvpr, rehabilitation is through exercise and education. John Hospital’s pulmonary rehabilitation program is an education and progressive exercise program that is also medically supervised (2004). Pulmonary rehabilitation programs in some hospitals specify a condition to handle while others deal with a variety of pulmonary diseases. John Hospital’s pulmonary rehabilitation program includes patients with other lung disorders for example chronic bronchitis, emphysema, asthma and others including the common pulmonary disease; Chronic Obstructive Pulmonary Disease. There are pulmonary rehabilitation programs meant to deal with COPD alone (Barnett & Wells). John Hospital considers other patients because of the kind of patients that the hospital receives. Before implementation of the pulmonary rehabilitation program including other lung diseases, there was only the pulmonary rehabilitation program for COPD patients. Based on a research conducted on the hospital in 2004 on the frequency of visits and number of patients with other pulmonary disorders, after scientists proposed the use of a rehabilitation program for other lung diseases because of its efficiency in COPD patients, the program combining all the diseases was implemented. The hospital does not receive only COPD patients but so many patients with different lung disorders like asthma, emphysema and many others. The National Guidelines for Creation of a Pulmonary Rehabilitation Program and John Hospital’s Rehabilitation Program According to the National guidelines, any out patient pulmonary rehabilitation program should have the essential components of a pulmonary rehabilitation program. These as had been noted above are the exercise training program, psycho- social intervention, the educational component, the patient evaluation, necessary treatment methods that ensure patient health status management and follow-up processes (NICE, 2004; BTS Statement, 2001). John Hospital’s pulmonary rehabilitation program has all the components required by the national guidelines for a pulmonary rehabilitation program. Program length and sessions are dependent on the each program. A pulmonary rehabilitation team should consist of a respiratory care practitioner, psychologist, physician, specialized nurses, dietitian and other relevant medical professionals (NICE, 2004). All these are present in John hospital pulmonary rehabilitation program with most of the professionals being extended members due to unavailability of enough professionals and their roles. The Psychosocial intervention should deal with the dependency and support system (NICE, 2004). Psychosocial intervention in John hospital is provided by the team members including counselors who are invited when needed. Exercise training is meant for conditioning and strengthening. Patients who have COPD cannot improve even with education in disease management techniques. Exercise training programs have to be implemented for them to improve (NICE, 2004). John hospital pulmonary rehabilitation program has an exercise training program and facilities that certifies this requirement. The hospital has different exercise equipments for different exercise meant to achieve different aims in different patients according to patient needs. As mentioned above for example, COPD patients are different and require different treatment. This is not ignored by the hospital’s rehabilitation program as earlier described by the programs delivery of services. Pulmonary rehabilitation program patients should be stable and not affected by other unstable or serious medical conditions such as organic brain syndrome, congestive heart failure, dementia, severe liver dysfunction, substance abuse, disabling stroke, acute corpurmonale, meta-static cancer and many others (NICE, 2004). In John Hospital’s program, this is ensured by patient assessment which qualifies a patient to be enrolled as a candidate for the program. Follow-up should be a structured rehabilitation program (NICE, 2004). Just as had been noted earlier, without follow-up, the resources and efforts put on the rehabilitation program would go to waste. The idea of ensuring reduced expenses in health care would not be achieved and there will be no benefits of this program. The patients have to be followed-up to ensure the patients are doing fine. This phase of the rehabilitation program is included in John hospital’s pulmonary rehabilitation program with follow-up procedures and additional facility for continued exercise after graduation from the first phase of the program. The respiratory function of the patients should be measured and their progress documented (NICE, 2004). John hospital’s program ensures this by communicating with the hospital’s pulmonologist and patients’ physicians o patients’ progress. Progress is measured by a comparison of the patient’s status on admission to the current state when a report is made. It is determined by the oxygen saturation levels, heart rate, blood pressure measured in each exercise session. Conclusion Pulmonary rehabilitation program has proved effective on COPD patients and its implementation in hospitals would reduce death cases due to such a lung condition. The BTS statistics indicated the number 600,000 of patients likely to die if pulmonary rehabilitation programs are not implemented in London. This shows how important this program is to the nation. The program has also benefits to the patients apart from the general benefits to the nation. This paper has described the rationale of including a pulmonary rehabilitation program in a hospital in London. The rationale has considered the available resources of the region, the national guidelines of the region, the evidence of efficiency of the program and the clinical guidelines for creation of a pulmonary rehabilitation program. Based on these factors, it is important to include a pulmonary rehabilitation program in the hospital that will help patients who need such kind of treatment. References American Association of Cardiovascular &, American Association of Cardiovascular & Pulmonary Rehabilitation, Aacvpr. (2004). Guidelines for Pulmonary Rehabilitation Programs.Ed. 3. Illinois, USA: Human Kinetics. Barnett, M. and Wells, J. Pulmonary Rehabilitation Program for Patients with COPD Protocol v1:2 . Plymouth Teaching Primary Care Trust. Retrieved on 8th June 2009 from: http://www.plymouthpct.nhs.uk/CorporateInformation/policiesprocedures/Documents/Clinical%20Guidance/Pulmonary%20Rehabilitation%20Programme%20for%20Patients%20with%20COPD%20Protocol%20v1.2%20(PPCTG396).pdf BTS COPD Consortium. Practical Pointers: Pulmonary Rehabilitation: Summary of Key Issues. Retrieved on 11th June 2009 from: http://www.britthoracic.org.uk/Portals/0/Clinical%20Information/COPD/COPD%20Consortium/A5BTSPulmonarystg4.pdf BTS Statement. (2001). Pulmonary Rehabilitation: British Thoracic Society Standards of Care Subcommittee on Pulmonary Rehabilitation. Thorax, (56)827–834. Retrieved on 11th June 2009 from: http://www.britthoracic.org.uk/Portals/0/Clinical%20Information/Pulmonary%20Rehabilitation/Guidelines/Pulmonaryrehab.pdf Ehrman, J. K., Gordon, P., Visich, P. S. and Keteyian, S. J. (2008). Clinical Exercise Physiology. Ed. 2. London, UK: Human Kinetics. Fishman, A. P. (1996). Pulmonary Rehabilitation. New York, USA: Informa Health Care. Garrod, R. (2003). The Effectiveness of Pulmonary Rehabilitation: Evidence and Implications for Physiotherapists. The Chartered Society of Physiotherapy. London UK. Retrieved on 8th June 2009 from: http://www.csp.org.uk/uploads/documents/evidencebrief_pulmonary_EB05.pdf Hui, K. P. and Hewitt, A. B. (2003). A Simple Pulmonary Rehabilitation Program Improves Health Outcomes and Reduces Hospital Utilization in Patients With COPD. Chest Journal 124(1). http://www.aamr.org.ar/cms/archivos/secciones/rehab/srpaamragosto.pdf. National Institute for Clinical Excellence (NICE). (2004). Chronic Obstructive Pulmonary Disease: National Clinical Guideline for Management of Chronic Obstructive Pulmonary Disease in Adults in Primary and Secondary Care. (59). Nici, L., Limberg, R., Hilling, L., Garvey, C., Normandin, E. A., Reardon, J. and Carlin, B. W. (2007). Clinical Competency Guidelines for Pulmonary Rehabilitation Professionals: American Association of Cardiovascular and Pulmonary Rehabilitation Position Statement. JCRP Journal. 355-358. Parsons, P. E. and Heffner, J. E. (2001). Pulmonary/Respiratory Therapy Secrets. Ed. 2. London, UK: Elsevier Health Sciences. Pauwels, R., Postma, D. S. and Weiss, S. T. (2004). Long-term Intervention in Chronic Obstructive Pulmonary Disease. Ed. 2.New York, USA: Informa Health Care. Rennard, I. S. (2007). Clinical Management of Chronic Obstructive Pulmonary Disease. Ed. 2. San Diego, California: CRC Press. Stein, J. H. (1998). Internal Medicine. Ed. 5. London, UK: Elsevier Health Sciences. Read More