Respiratory Specialist Nurses

Community Respiratory Specialist Nurses support the management and provide assessments of patients with established respiratory diagnoses through clinics reviews and home visits.

GPs and Practice nurses can send referrals via cpn-tr.MidRespiratoryTeam@nhs.net

Roles of the Specialist Respiratory Nurses:

1) Long Term Oxygen Therapy Assessment using an Arterial Blood Gas.

 Criteria: The patient:

• Must have a respiratory diagnosis
• Must have had other treatment options optimised
• Must be 8 weeks clear of an exacerbation
• Sp02 must be persistently below 92%
• FEV1 <30%

Exclusions:

• Current smokers
• Risky behaviour with drugs and alcohol

Patients can be assessed for Ambulatory oxygen. The assessment involves a 6 minute walk to test for improvement in exercise tolerance.

2) Patients with Frequent Exacerbations and Admissions

The respiratory specialist nurses can review patients to support optimising treatments and creating admission avoidance strategies.

3) Assessing the need for nebulisers

There is poor evidence for the efficacy of nebulisers. The role of the specialist nurse is as a gate keeper to avoid inappropriate use.

All NIV and CPAP support queries should be via the respiratory clinic 01872 252640

4) Palliative Symptoms Support

The respiratory specialist nurses can support palliative respiratory patients with the use of fan therapy and palliative oxygen. Consider palliative oxygen if sp02 <92%.

Palliative oxygen therapy

• Patients with cancer or end-stage cardiorespiratory disease who are experiencing intractable breathlessness should not receive treatment with palliative oxygen if they are non-hypoxaemic or have mild levels of hypoxaemia above current LTOT thresholds (SpO₂ ≥92%).
• Patients with cancer or end-stage cardiorespiratory disease who are experiencing intractable breathlessness should receive assessment for a trial of treatment with opiates from an appropriately trained healthcare professional.
• Patients with cancer or end-stage cardiorespiratory disease who are experiencing intractable breathlessness should receive assessment for a trial of treatment with non-pharmacological treatments including fan therapy from an appropriately trained healthcare professional.

Good practice point

• Palliative oxygen may on occasion be considered by specialist teams for patients with intractable breathlessness unresponsive to all other modalities of treatment. In those instances, individual formal assessment of the effect of palliative oxygen on reducing breathlessness and improving quality of life should be made.

5) Pulmonary rehabilation

To refer please see: 
https://rms.cornwall.nhs.uk/primary_care_clinical_referral_criteria/primary_care_clinical_referral_criteria/respiratory/pulmonary_rehabilitation

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