Post hospitalization management of patients with COPDNursing Management (Springhouse): January 2018 - Volume 49 - Issue 1 - p 1 doi: 10.1097/01.NUMA.0000530022.11070.64 CE Connection GENERAL PURPOSE: To provide information about a study to improve post hospitalization management of patients with COPD and reduce readmission rates. LEARNING OBJECTIVES/OUTCOMES: After completing this continuing-education activity, you should be able to: 1. Identify the challenges and factors related to readmission of patients with COPD. 2. Discern transition theory and how it's used to reduce readmissions. In the United States, managing patients with COPD carries an annual cost of about$500 million.$13.2 billion.$32 billion.When readmissions occur for patients with COPD, the Centers for Medicare and Medicaid Servicesimposes penalties on hospitals.holds staff accountable.requires follow-up documentation for each patient.Attempts to reduce the risk of COPD readmissionhave resulted in evidence-based strategies for patient care.have resulted in a dramatic reduction in readmissions since 2013.may involve many contributing factors unrelated to COPD.This improvement project to reduce COPD readmissions encompassed all of the following exceptAmerican Medical Association guidelines.Canadian Thoracic Society guidelines.American College of Chest Physicians guidelines.The national readmission rate for COPD patients using Medicare is20%.30%.40%.An analysis of causes for COPD readmissions in this study showedincorrect use of inhaled medications.inconsistent postdischarge follow-up by the transition nurse.lack of understanding about taking medications.Recent studies addressing reduction of COPD readmissions supportthe use of pulmonary rehabilitation.frequent visits by the home healthcare nurse.the use of physical and occupational therapy.Studies focusing on reduction of readmissions for patients with COPD support all of the following exceptself-management education.medication management.weekly calls from the transition nurse.The trajectory of a patient's adaptation to COPDis linear.is predictable.is individual and variable.Which wasn't a causative factor for readmission?psychosocial factorsmisdiagnosis and errorshealth system complexityAn individualized and holistic transition should include medical intervention, emotional support, andfinancial planning.lifestyle promotion.psychosocial counseling.When discharged following a COPD exacerbation, patients experience role transition that changescomprehension and cognizance.reasoning and analytical thinking.behavior and definition of self.The LACE Index Scoring Tool calculates readmission risk by factoring inthe patient's age.comorbidities.documentation of adherence to the medication regimen.A method used to optimally manage the transition of COPD patients wasfollow-up with an internist in 3 to 4 weeks postdischarge.referral to an occupational therapist.education on the use of scheduled and as-needed medications.The 2017 readmission rate using new guidelines for COPD transition management in comparison with 2016 was8.3% lower.38% lower.unchanged.Using this quality improvement project, an important finding wasa coordination gap between inpatient and outpatient services.lack of referral to phase two pulmonary rehabilitation.lack of transportation to scheduled appointments.With limited resources to treat patients with COPD, the researchers recommendusing a standardized treatment protocol.targeting interventions to the highest-risk patients.delegating discharge planning responsibilities to others.A key concept from this research is thatthe results are easily generalizable to most large organizations.use of a theoretical framework was unnecessary and cumbersome.nurses are the key to successful case management of chronic conditions.Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.