Named Responsible Officer Approved By Date. Clinical Services Manager Clinical Procedures Group July 2010

Transcription

1 PROCEDURE FOR THE USE OF SPIROMETRY IN WIRRAL INTERMEDIATE CARDIAC CLINICS (WICC) Issue History October 2006 July 2010 Issue Version Two Purpose of issue/description of change To assist WICC practitioners to achieve accurate and safe lung function tests using Spirometry, for patients attending WICC Planned Review Date 2013 Named Responsible Officer Approved By Date Clinical Services Manager Clinical Procedures Group July 2010 Policy File:- D11 Impact Assessment Screening Complete-Date Oct 2010 Full Impact Assessment Required- No UNLESS THIS VERSION HAS BEEN TAKEN DIRECTLY FROM NHS WIRRAL WEB SITE THERE IS NO ASSURANCE THIS IS THE CORRECT VERSION

2 PROCEDURE FOR THE USE OF SPIROMETRY IN WIRRAL INTERMEDIATE CARDIAC CLINICS (WICC) INTRODUCTION Spirometry is used within the Wirral Intermediate Cardiac Clinics at the request of the General Practitioner with a Specialist Interest in Cardiology (GPwSI) or the Cardiologist on duty to assess a patient s lung function as part of the patient assessment process for consideration for cardiac angiography or cardiac surgery. PROCEDURE AIM This procedure aims to promote safe and effective administration of Spirometry within Wirral Intermediate Cardiac Clinics performed via GpwSI/Consultant request, when the patient is clinically stable and free from chest infection for 4 weeks. PROCEDURE OUTCOME All clinical staff will comply with this procedure TARGET GROUP All Registered Nurses and Clinic Technical Staff who have attended basic training and work in the Wirral Heart Support Centre. QUALITY CONTROL EasyOne Spirometry Kits to be maintained as per manufacturer s instructions. TRAINING Related mandatory in-house training. All registered nurses must have completed a self assessed clinical procedures competency to perform Spirometry tests as part of their annual appraisal All clinical technical staff must have their competency assessed by a registered nurse. RELATED POLICIES Please refer to relevant NHS Wirral Policies and Procedures. Page 1 of 5

3 EXCLUSION CRITERIA The test should not be performed on patients who have had any of following within the last three months: Myocardial infarction Major surgery Hernia repair Pneumothorax Eye surgery Ear Infection 3 rd Trimester pregnancy Unstable angina Unstable hypertension Haemoptysis of unknown origin This list in not exhaustive PREPARING THE PATIENT The patient must avoid eating a large meal for two hours before testing Refrain from smoking for 24 hours before testing Avoid drinking alcohol 2 hours before testing Avoid taking short acting bronchodilators 6 hours before testing Avoid taking long acting bronchodilators for 12 hours before testing Avoid taking sustained release theophyllines 24 hours before testing Patients must empty their bladder immediately prior to test Remove dentures ONLY if they are very loose These requirements may be difficult to meet and any deviation should be recorded The patient should be seated for the test and allowed to rest for a minimum of 5 minutes beforehand. Any restrictive clothing should be removed. Page 2 of 5

4 PROCEDURE/RATIONALE Procedure Explain the purpose and procedure of test to patient and obtain consent (see appendix 1) Decontaminate hands prior to procedure. Rationale Patient able to participate more effectively and understand nature and purpose of procedure. To reduce the risk of transfer of transient micro-organisms on the healthcare workers hands. Switch on EasyOne Spirometer. Following visual prompts enter patient data (gender, age, height, ethnicity) and prepare spirometer for use. Ensure accurate patient height without shoes, or fingertip to fingertip span in patients with spinal defect, is recorded. To record accurate patient data and prepare monitor for use. To ensure patient measurements can be accurately compared to predicted measurements. Insert single use disposable spirette, maintaining a seal with plastic cover, according to visual instructions. Patient must be seated upright throughout procedure. Perform test by: Ensuring lungs filled completely (full inspiration) Lips sealed around spirette. Blowing out forcibly as hard and fast as possible upon visible prompt. Give encouragement to patient to blow forcibly and continue to blow until lungs are empty. Continue blowing out until lungs are completely empty. Observe patient throughout the procedure. To prevent fainting. To ensure reliable test. To avoid leakage. To ensure test quality. To complete test. To maintain accuracy of the blow. Page 3 of 5

5 After each manoeuvre, review message prompt on screen. Repeat as required, allowing for patient to recover between each blow. Maximum of eight blows per session. Dispose of spirette as per NHS Wirral Policy. Decontaminate hands. Decontaminate equipment. Print a report. Ensure patients name, date of birth and NHS number is on report. Submit printed report to requesting physician. Check test quality. To prevent fatigue or induced bronchospasm. To comply with waste management policy. To remove the accumulation of transient micro organisms. Cleaning of equipment minimises the risk of cross infection. Record of procedure. Timely interpretation of results. CLINICAL INCIDENTS Any related incidents arising from this procedure, which may involve a clinical error or near miss, must be reported following NHS Wirral Incident Reporting Policy. REFERENCES NICE guidelines for Chronic Obstructive Airways Disease (2004) Spirometry in Practice (2005) A Practical Guide to Using Spirometry in Primary Care, 2 nd Ed. The British Thoracic Society COPD Consortium. USEFUL WEBSITES Page 4 of 5

6 Appendix 1 INTERMEDIATE CARDIAC CLINIC SPIROMETRY QUESTIONAIRE Has the patient suffered from any of the following conditions in the past three months YES NO Myocardial Infarction. Stroke/ TIA. Unstable Angina. Major Surgery. Pnuemothorax. Eye Surgery. Grommets Insertion. Abdominal Surgery.. Haemoptysis of unknown origin... Has the patient suffered form a chest infection in the past month? YES. NO.. Are you on a course of oral steroids or antibiotics? YES. NO.. Patient Name.DOB Patient Signature. Date Staff Name Staff Signature.,. Designation.Date. Please complete prior to undertaking the test Page 5 of 5