Authors (including presenting author) :
K Leung, KM Chan, LF Chan, K Chan, YM Lee
Affiliation :
Department of Tuberculosis & Chest, TWGHs Wong Tai Sin Hospital
Introduction :
Introduction
In 2019, first reported Severe Acute Respiratory Syndrome Coronavirus 2 ( SARS-CoV-2) infection case was found . This infection spread quickly internationally. It had impacted the daily lifestyle, global economic, health care pattern and psychological status among different people. Chronic Obstructive Pulmonary Diseases (COPD) is one of the risk factor accountable for severe diseases in Coronavirus and many COPD patients depend on long term Oxygen therapy in order to maintain their life quality. In Hong Kong, patients with COPD were being locked down at home under Coronavirus pandemic. More importantly, medical follow-up appointments in recent 3 months were cancelled. Poor home-use Oxygen compliance and serious complications may come along with this difficult situation. “Tele-monitoring Home Oxygen User Pre-discharge”( THOU ) program has been launched in WTSH, DTBC departments since 2006. This program provided various information to individual patient for pre-discharge instructions. Moreover, post-discharge phone calls appeared even when their abnormal overnight oximetry reports were detected when they were “ locked-down” at home. There were some enhancement measures implemented in this program that could help those COPD patients which were using long-term Oxygen during pandemic
Objectives :
The objectives of the program for home-use oxygen patients under Coronavirus pandemic:
1. To enhance the knowledge and skills in managing home oxygen use for patients and their care-taker after discharged.
2. To detect the sub-sequence problems earlier, it indicated us to arrange further treatment for the patients quicker.
3. To decrease unplanned re-admission.
4. To show patients empathy by telling them that they are not alone while facing the great challenge of pandemic.
Methodology :
Methodology
Comprehensive assessment including willingness of using long term Oxygen at home, financial status, ability of operating and maintaining home Oxygen concentrator, relevant family support and potential technical difficulties about home Oxygen information ; Also, tailor-made education (including hours of using home Oxygen, fire hazard, personal hygiene, physical hazard, life style modification that complies home oxygen therapy, smoking cessation, vaccination and their benefit on survival and exercise capacity ) were given. Nevertheless, the above-mentioned assessments could not be conducted to the care-taker directly due to the “No visit” policy established by Hospital Authority during Coronavirus pandemic period. Therefore, the nurses could only complete the assessments via phone to provide home use Oxygen therapy information. The baseline overnight oximetry would be arranged before patients discharge. Follow-up overnight oximetry would be normally arranged two to five weeks after the patients were discharged. If abnormal report was detected through tele-monitoring method in between, the subject officer would arrange earlier follow-up treatment. This can make patient in need can receive the medical care timely.
Result & Outcome :
Result
Form December 2019 to May 2020, there were 64 patients recruited into this program and the mean age was 67. 45 patients were willing to preform second overnight oximetry after discharged, 15 overnight oximetry abnormal reports were detected , 10 reports of nocturnal desaturation with significant hypoxaemia ( average nocturnal time SaO2 80-85% ) and 5 reports of patients were reluctant to use Oxygen therapy after discharged ( average nocturnal time SaO2 84-89% ) . Subject officer would provide phone counselling and nursing reinforcement education to patients and their carrier, this can make sure they could understand and rectify their oxygen-using habit.
2 hypoxaemia patients were required to refer admission for further investigation. After 8 weeks later, 13 follow-up overnight oximetry were received. 8 hypoxaemia patients with significant improvement were shown ( average nocturnal timeSaO2 ramp to 92-95%) , and all 5 patients changed their mind and willing to use Oxygen therapy ( average nocturnal time SaO2 94-96%) that were reluctant to use Oxygen therapy previously.
Conclusion
The enhancement service benefits home use oxygen patients, it can prevent some unplanned readmission and reduce the burdens on acute medical service. Moreover, it can let patients and the carrier to know that they are not alone while facing the great challenge of pandemic.
