Lung Health Education Al and Preventative Health Event
Lung Health – Educational and Preventative Health Event
Participant Guide
Introduction
Pharmacists are well-positioned to provide education and preventive health initiatives for the benefit of patients and the public.
This guide describes a Lung Health service that has been successfully prototyped by pharmacy students and pharmacists at the UBC Pharmacists Clinic. The clinical and procedural materials have been modified to enable any pharmacist to provide a similar service using equipment and materials routinely available in a community pharmacy.
The service includes the following components:
· Information on the structure and function of the lungs
· Measurements of lung function: Respiratory rate and pattern, and peak expiratory flow
· Information on factors that impact lung health and assessment of personal risk factors
· A personalized plan for maintaining healthy lungs and managing lung conditions when present
To ensure accountability and compliance with regulatory requirements, all health care services should be provided by licensed pharmacists, pharmacy students supervised by a licensed pharmacist or other regulated health care professionals.
NOTE - This guide does not cover logistic and business aspects of organizing a health event such as: advertising, where to hold the event, identifying participants, booking appointments, charging fees, liability issues, offering service to local businesses, etc.
About the Pharmacists Clinic
The Pharmacists Clinic, locatedat theUBC Faculty of PharmaceuticalSciences, is a university-affiliated, licensed, pharmacist-led patient care clinic with a mandate to:
· Be a model of patient care best-practices
· Provide learning and skill development opportunities for health professionalsand students
· Be a living lab that contributes service models, systems, processes, research and program evaluation for the health care community.
More information about the Clinic is available here: https://pharmsci.ubc.ca/pharmacists-clinic
Service Approach
Participants are typically scheduled at 15 minute intervals with the total appointment time being about 20 minutes, although this may vary.
Two options for service delivery are:
· Participants move from station to station and receive part of the service at each station
· Participants receive all services from one person
· If enough pharmacists/students are available, 2 or 3 participants can receive service at the same time in parallel service streams.
Participants receive a Lung Health Passport where information about their health is recorded and they will take home. NOTE – the pharmacy needs to also keep a record of service provided. This can be done using an excel spreadsheet, taking a copy of the completed passport or using an electronic record.
The order of service is at your discretion, however, experience has shown that the following step-wise approach provides a logical flow.
Station* (if used) / Step in Passport / Service DescriptionA / Register participant in pharmacy record and give passport
1 / Complete the “About Me” section
B / Explain the structure and function of the lungs
2 / Check hMeasure height, weight, BMI, respiratory rate, breathing pattern, lung conditions and lung-related symptoms
2-53 / Complete the “My Body”, “My Breathing”, My Lung Conditions” and My Symptoms sectionsNote breathing pattern
C / 74 / Measure lung function (peak flow) Complete “Known Lung Conditions” section
8 / Complete the “My Risk Factors” section
6 / Complete the “Current Medications” section
5 / Complete “Lung Related Symptoms” section
6 / Measurement of lung function (peak flow)
7 / Interview patient to determine risk factors for lung disease
8 / Complete the “Current Medications” section
D / 9 / Interpret results and establish “My Plan” with the patient
10 / Pharmacist signs the passport
Copy of information in the passport is retained at the pharmacy and patient takes the passport.
*If service offered in stations, Station A can be manned by an administrative person. Stations B and C can be manned by pharmacy students with pharmacist supervision. Station D is for the licensed pharmacist.
Materials
In addition to this Guide, materials provided for use at a Lung Health event are:
· Lung Health Passport
· Images (to print or load onto an iPad and have available at Station B)
· Clinical Resources (to have available at Stations C and D)
· Images (to print or load onto an iPad and have available at Station B)
· Recommended list of supplies to have on-hand
Preparatory Readings
Clinical people (pharmacists/students) who will be providing service in the Lung Health event are encouraged to read the following materials so they are familiar with the elements of lung health being measured and discussed:
1. Overview of lung anatomy and physiology
The Lung Association – Respiratory System
https://www.lung.ca/lung-health/lung-info/respiratory-system
The Lung Association – - Breathing
https://www.lung.ca/lung-health/lung-info/breathing
Animations of respiration:
https://www.youtube.com/watch?v=k4uNapAUCQU
https://www.youtube.com/watch?v=eGicIbMde2E
2. O2 Sat explanation
http://www.pulseox.info/pulseox/what2.htm
https://www.thoracic.org/patients/patient-resources/resources/pulse-oximetry.pdf
23. Peak flow meter overview
http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/asthma/living-with-asthma/managing-asthma/measuring-your-peak-flow-rate.html
34. Proper breathing techniques
https://www.youtube.com/watch?v=JeDiS7MWXNk
45. Immunization
Influenza: http://www.healthlinkbc.ca/healthfiles/hfile12d.stm
Pneumococcal: http://www.healthlinkbc.ca/healthfiles/hfile62b.stm
Service Delivery - Step-by-Step
Station A
“Welcome to our Lung Health event. You will be receiving information about your current health status and habits that impact on the overall health of your lungs. Information will be recorded in a passport for you to take with you. To start, we will record your name, year of birth, your gender and today’s date. Please proceed to the next station.”
Station B
“At this station, I will explain how lungs function, we will record information about you and your lung health and we will check the way you breathe measure your breathing and oxygen level in your blood. Do you have any questions before we start?”
Discuss kKey messages:
(use images and pictures to facilitate discussion and provide context)
1. Your Our lungs have an important role in keeping youus strong and well.
· Most people take their lungs for granted until they experience problems with breathing. The reality is, like the rest of our body, our lungs need daily care and attention.
· Lungs at rest and during most daily activities are working at only 50 percent of their capacity. This means we have some reserve if something goes wrong, but it also means we can have a serious lung disease, yet show no symptoms.
· Chronic lower respiratory (lung) disease is in fact the 4th leading cause of death in Canada (2014 StatsCan)
2. The lungs are part of a complex apparatus, expanding and relaxing thousands of times each day to bring in oxygen into the body and expel carbon dioxide out
· Review diagram of respiratory system (you may elect to show an image for )
https://www.lung.ca/lung-health/lung-info/respiratory-system
Respiratory tract component / Function / PathologyAirways (Trachea/windpipe, bronchi and bronchioles) / Conduct air
Trachea branches into bronchi, which in turn branch to
become progressively smaller tubes throughout the lungs / -Asthma (chronic airway inflammation)
-COPD (inability to exhale normally)
-Viral bronchitis
-Allergies
-Cystic fibrosis: Cannot clear mucus
-Sleep apnea (often upper part of airway due to neck anatomy)
Air sacs (Alveoli) / At the end of the airways, involved in gas exchange / Pneumonia, influenza, TBtuberculosis, emphysema, lung cancer
Interstitium / Microscopically thin, delicate lining between the air sacs. Tiny blood vessels run through interstitium and allow gas exchange between alveoli and blood / Interstitial lung disease, pneumonias
Blood vessels / Ranges from sRange from smalmall ones in the interstitium to the large ones that move blood both ways between the from the body and to the lungs and back again / Pulmonary embolism, pulmonary hypertension
Pleura / A thin lining of tissue surrounding lungs and inside the chest wall (rib cage). A tiny layer of fluid allows pleura on the lung’s surface to slide along the chest wall with each breath. / Pleural effusion, pneumothorax, mesothelioma (post asbestos)
Chest wall / Muscles that connect ribs to each other and help chest expand and
contract for breathing. / Obesity: Extra weight on chest and abdomen hinders chest’s ability to expand
Neuromusuclar disorders: paralysis, ALS, muscular dystrophies
Diaphragm / A muscle between the lungs and abdomen that descends with each breath in, also causing chest expansion to move
air into and out of the lungs / Neuromuscular disorders (Paralysis, ALS)
· Use videos to explain the physiology of breathing and gas exchange
https://www.youtube.com/watch?v=eGicIbMde2E
· Gas exchange
https://carolgiglioibbio2.files.wordpress.com/2012/11/gas_exchange_lungs1.jpg
3. I’m now going to gather some general information about youGather general information regarding the patient
· Record age and gender
· Measure hHeight and , weight
· C, calculate BMI using any calculator (BMI = kg/m2).
· Check respiratory rate (RR) by watching and counting how many breaths a person takes in 10 or 15 seconds and then calculate the breaths/minuteat this time
4. Pre-existing lung disease screen
· Review lung diseases checklist and (CCircle Y/N based on known conditions/diagnoses:)
-Asthma
-COPD
-Allergies (environmental)
-Sleep apnea
-Lung infection in last 12 months
-Other (note manually on the passport)
Specific questions about signs and symptoms that can indicate a problem with the lungs:
Review symptom checklist and circle all that apply:
· Shortness of breath
· Wheeziness
· Pain with breathing
· Persistent cough
· Voice hoarseness
· Loss of appetite/weight loss
· Snoring
· Daytime fatigue
· Waking up from sleep choking/gasping
· Morning headaches
“You are ready to move on to Station C where we will assess for any lung related symptoms you may be experiencing, do a measure to assess lung capacity and ask about lifestyle factors and health conditions that can influence lung health. Then you will meet with the pharmacist for a consultation on your results.”
Station C
“At this station we are going to check for any lung related symptoms you may be experiencing, measure your lung capacity, assess lifestyle factors that contribute to life-long healthy lungs and briefly review any medications you are currently taking. Do you have any questions before we start?”
1. Specific questions about signs and symptoms that can indicate a problem with the lungs:
Review symptom checklist (circle):
-Shortness of breath
-Wheeziness
-Pain with breathing
-Persistent cough
-Voice hoarseness
-Loss of appetite/weight loss
-Snoring
-Daytime fatigue
-Waking up from sleep choking/gasping
-Morning headaches
2. Measure Peak expiratory flow
Discuss Key messages:
-Peak flow measures your ability to push air out of your lungs in liters per minute. Lung conditions that cause airway damage or inflammation may affect this measurement
-A "normal" peak flow rate is based on a person's age, height, sex, race and physical health. Peak flow generally increases from childhood to adulthood, with height and is generally higher in males due to increased lung size. Caucasians typically have greater peak flows vs. other races.
Directions for using Peak Flow Meter:
· Ensure a disposable mouthpiece is used for each patient and that the mouthpiece of the peak flow meter is sanitized with an alcohol swab
· Step 1: Before each use, shake the meter vertically to make sure the sliding yellow marker is at the bottom of the numbered scale
· Step 2: Have patient stand up straight (may sit if unable to stand). Remove gum or any food from mouth. Instruct them to take a deep breath (as deep as they can). Ask them to put the mouthpiece of the peak flow meter into their mouth forming a tight seal with their lips and ensuring tongue is away from the mouthpiece. In one breath, have them blow out as hard and as quickly as possible: “blow a fast, hard blast until you have emptied out nearly all of the air from your lungs”.
· Step 3: Note the PEFR in L/min in the Passport.
· Step 4: Repeat the entire routine three times. (You know you have done the routine correctly when the numbers from all three tries are very close together.)
· Step 5: Use their best reading as compared to expected value to determine where they fall (80-100%, 50-79%, <50%) and note in passport.
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3. Assessment of risk factors that can aeffect for optimization of lung health
Complete risk factor checklist:
· Smoking (current or recent) and pack year history
i. Describe what smoking does to the lungs and the good news that no matter how long someone has smoked, the lungs can heal themselves when smoking stops
1. “15 years post smoking” diagram
http://www.dailytimesgazette.com/heart-failure-risk-for-smokers-return-to-normal-15-years-after-quitting/14257/
2. Healthy lung vs. smoker’s lung picture
· Risk factors for lung infections: Age≥65, chronic disease, weakened immunity
· Occupational/environmental exposures
i. http://www.healthlinkbc.ca/healthtopics/content.asp?hwid=hw161562
· Sedentary (<30 min of physical activity - where the heart rate goes up and some sweat forms -- most days/week)
· Obesity/overweight – BMI >24.9
i. Note limitations of BMI
· Chest breather or use of accessory muscles (as self identified during station 2)
· Immunization status
i. Influenza (yearly)
ii. PneumoccoalPneumococcal
4. Record medications
· Collect medication (Rx, OTC and NHP) information from the patient (what you take, why you take it, how you take it)
· You are not expected to perform a detailed medication history, simply ask if they are taking any regular medications and make note of the drug name
“You are ready to move on to Station D where the pharmacist will go over all the information we’ve gathered, discuss your results and answer your questions.”
Station D (Pharmacist)
“At this station, we will review your measurement results, risk factors and go over any questions you have. We will then will talk about a plan for you to maintain optimal lung health.”
For all participants: Emphasize ways to optimize lung health, educate on meaning of Peak flow measurements, answer questions, assess if influenza or pneumococcal vaccines appropriate, refer if required.
Pharmacist will take oneOne of the following 3 approaches can be taken tofor this consultation, depending on the patient’s status. Alternatively, focus could be on smoking cessation if patient identifies as being ready to quit and is seeking information.