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1 Sheraton

2 Welkom

3

4 Oprichtingsvergadering Brussel december 2003

5 Doelstellingen van BVPV-SBIP Organiseren van permanente vorming in functie van de opleidingsbehoeften Informatie- uitwisseling tussen zorgverleners en uniformiteit nastreven samen met de pneumologen. Verpleegkundig wetenschappelijk onderzoek stimuleren Uitbouwen en onderhouden van contacten met alle verpleegkundige verenigingen in binnen- en buitenland Promoten van kwaliteitsnormen en de behartiging van de beroepsbelangen van de leden.

6 Leden Lidmaatschap 10 euro / jaar Jaarlijks congres / eerste zaterdag van december Website : Aansluiting bij internationaal netwerk Korting inhalatieboek voor zorgverleners

7 Werkgroepleden Nederlandstalige Franstalige

8 Eerste vpk congres : Inhalatietherapie december 2004 Genval

9 Evidence based tekstboek Cathy Lodewijckx, UZ Leuven Daniel Schuermans, VU Brussel Actieve werkgroep BVPV : literatuur expertise Artsen: reviewing Prof. Decramer, Diensthoofd Pneumologie, UZ Leuven Prof. Dejongh, Longfysioloog, Medisch Spectrum Twente Prof. Dekhuijzen, Diensthoofd Pneumologie, UMC Nijmegen Prof. Derom, Kliniekhoofd Pneumologie, UZ Gent Prof. Verleden, Kliniekhoofd Pneumologie, UZ Leuven Prof. Vincken, Diensthoofd Pneumologie, AZ VU Brussel

10 Belgische Evidence Based Richtlijn Belgische richtlijn uniformiteit in voorschrijfgedrag, toediening, educatie Wetenschappelijk gefundeerd betere inzichten meer gebalanceerd gebruik van inhalatoren

11 Belgische Evidence Based Richtlijn Geïnspireerd door klinische expertise Praktische richtlijn overzicht huidige inhalatoren educatie m.b.t. inhalatietoestel en inhalatiemedicatie

12 Inhoudstafel Depositie van aërosolen in het respiratoir systeem Dosisaërosolen Voorzetkamer Droogpoederinhalatoren Verneveling Lokale bijwerkingen Educatie Patiëntenfolders evaluatiepapieren Inhalatiemedicatie

13 Doelgroep? Alle zorgverleners die in contact komen met inhalatietherapie

14 Hoe het boek aankopen / bestellen? Prijs: 26 Leden: 15

15 Rookstopcongres : december 2005 Oostende

16 Opleiding 2006: «Rookstop voor verpleegkundigen» (educatie-kit) RIZIV en RDQ ( Research, Development & Quality) Tervurenlaan Brussel 14/12/2006 van 14u tot 16u 12/12/2006 (franstalige) inschrijven via med.feedback@riziv.fgov.be of 02/ verpleegkundige per ziekenhuis

17 Verslag ERS Munchen 2-5 sept onderzoeksprojecten

18 Clinical pathway for acute COPD exacerbations reduces hospital stay and readmission Geert Celis, ERS Munchen

19 Clinical pathway for acute COPD exacerbations reduces hospital stay and readmission G. Celis RN, C. Lodewijckx RN, A. Schoonis RN, M. Decramer MD, PhD Pneumology Division, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Belgium BACKGROUND COPD patients have frequent hospital admissions and a longer hospital stay compared to other chronic illness. In 2000 we implemented a 10-day clinical pathway (CP) for acute COPD exacerbations. In May 2003 the duration was reduced to 8 days. The CP describes the tasks of the multidisciplinary team: medication, examinations, diet, physiotherapy, education among lifestyle modification and therapy, nursing care and discharge management. The aim of the CP is to standardise the treatment, to reduce the length of stay and to screen patients for a rehabilitation program. COPD Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7 Day 8 Day 9 Day 10 Medication M.Pr. 32mg per os M.Pr. 32mg per os M.Pr. 32mg per os M.Pr. 32mg per os M.Pr. 32mg per os M.Pr. 32mg per os M.Pr. 32mg per os M.Pr. 24mg per os M.Pr. 24mg per os M.Pr. 24mg per os Duovent 4x4 puffs Duovent 4x4 puffs Duovent 4x4 puffs Duovent 4x3 puffs Duovent 4x3 puffs Duovent 4x3 puffs Duovent 4x3 puffs Duovent 4x2 puffs Duovent 4x2 puffs Duovent 4x2 puffs AB if necessary Spirometry bedside Spir. body plethysmogr and TL,CO. Investigations Spir. bedside Spir. bedside Spir. bedside Spir. + Plethysmogr Spir. bedside Spir. bedside Observations Quadriceps force Hand grip strength, PImax PEmax RX thorax Observations Observations Observations RX thorax cycle ergometry Identification for ambulatory screening Outpatient rehabilitation or LVRS BGW Sputum Weight Observations Observations ABG without O2 Observations Observations Weight Weight CT- thorax Weight Bloodsamples Observations Sputum Weight O2 therapy O2 --> Sat > 90% O2 --> Sat > 90% O2 --> Sat > 90% O2 --> Sat > 90% O2 --> Sat > 90% O2 --> Sat > 90% O2 --> Sat > 90% O2 --> Sat > 90% O2 --> Sat > 90% O2 --> Sat > 90% StcO2 StcO2 StcO2 StcO2 StcO2 StcO2 StcO2 StcO2 StcO2 StcO2 Dyspnea-score Dyspnea-score Dyspnea-score Dyspnea-score Dyspnea-score Dyspnea-score Dyspnea-score Dyspnea-score Dyspnea-score Dyspnea-score Pluridisciplinary Medical history COPD checklist by knowledge Checklist discharge MD assessment preparation Team Prescription fysioth. self care behaviour Prescription investigations Nurse intake Dietician Pat. Activities Hygiene Hygiene Hygiene Hygiene Hygiene Hygiene Hygiene Hygiene Hygiene Hygiene PT/Rehab PT/Rehab PT/Rehab PT/Rehab PT/Rehab PT/Rehab PT/Rehab PT/Rehab PT/Rehab Pluridisciplinary Education Inhalation medication Inhalation medication Diet Inhalationmedication Evaluation inhalation Evaluation inhalation Smoking cessation Evaluation methods methods inhalationmethods Discharge Evaluation Check discharge preparation homesituation criteria Contact Social worker Check discharge criteria Critical Pathway displayed by day Medical Doctor (MD) and Respiratory nurse tick the activities to be performed. M.Pr. : Methylprednisolone; StcO2: Transcutaneous oxygen saturation; PT/Rehab : Physiotherapy or Rehabilitation; ABG : Arterial blood gases; LVRS : Lung volume reduction surgery Mean HOSPITAL STAY Readmission interval during the first year after discharge Reeks1 AIMS OF THE STUDY To explore the benefit of a clinical pathway: on the hospital stay and the readmission interval in patients hospitalized due a COPD exacerbation. METHODS A retrospective study. 68 CP patients and 94 control patients hospitalized due an COPD exacerbation during the year RESULTS The mean hospital stay for CP patients was days (SD ) and the control group had a mean hospital stay of (SD )(P=0.034). During the first year after discharge 35.3% of the CP patients had a mean readmission interval of 161 days (SD ) and 34% of the control group had a mean readmission interval of days (SD )(p= 0.029). CONCLUSIONS Patients hospitalized for an acute COPD exacerbation and involved in a clinical pathway have a significantly shorter duration of hospital stay and a significantly higher readmission interval during the first year after discharge.

20 COMPARISON OF CARBON MONOXIDE (CO) MONITORING TO URINE COTININE (COT) ANALYSIS TO DETECT TOBACCO USE IN LUNG TRANSPLANT RECIPIENTS Annemie Schoonis, ERS Munchen

21 COMPARISON OF CARBON MONOXIDE (CO) MONITORING TO URINE COTININE (COT) ANALYSIS TO DETECT TOBACCO USE IN LUNG TRANSPLANT RECIPIENTS A. Schoonis RN, N. Cuvillier RN, C. Lodewijckx LN, B. Bouckaert MD, L. Dupont MD,PhD, D. Van Raemdonck MD,PhD, G. Verleden MD,PhD Pneumology Division, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Belgium BACKGROUND End-stage smoking-related COPD is one of the major indications for lung transplantation. While almost all lung transplant patients claim that they have quit smoking, we suspect that a considerable amount of these former smokers continue smoking since there is evidence that smokers are likely to misrepresent their smoking status. Previous studies show that urine COT analysis is more accurate than CO monitoring to detect tobacco use. AIMS OF THE STUDY The purpose of this study was to detect tobacco use in lung transplant recipients and to compare the efficacy of CO monitoring to urine COT analysis. N= (58%) Group 2 63 ( 42%) non-smokers before transplantation smokers before transplantation Group 1 Fig 1 Smoking behaviour before lungtransplantation (LTX) non-smokers before smokers before METHODS A single-center, observational study was performed in 149 lung transplant patients of whom 86 were former smokers. During follow-up consultation, all patients were questioned about their smoking history and their current smoking habits. Smoking habits were also evaluated by means of urine COT analysis and CO monitoring Emphysema Alfa-1-AT Cystic fibrosis PPH Pulm. Fibrosis Bronchoectasia Eisenmenger Kartagener other Fig 2 Smoking behaviour before LTX by disease Fig 3 pico Smokerlyser Fig 4 CO reference value Fig 6 Group 2 : 5 LTX patients with a positive CO result RESULTS The urine cotinine analysis identified 15 smokers. All of them were former smokers. 10% (15/149) of all lung transplant recipients and 17.4% (15/86) of former smokers were cotinine positive. Only 2 out of 15 (13%) reported initially to be currently smoking. After confrontation of the cotinine positive patients with repeated positive cotinine test results, 9 of the 14 cotinine positive patients eventually also admitted to have been started smoking again after transplantation (fig 8) CO monitoring classified 19 (12.7%) lung transplant recipients as smokers : 10 light smokers (11-19 ppm) and 9 heavy smokers (25-58 ppm). Nine of them were cotinine negative. Only 4 out of 9 were former smokers, suggesting that CO monitoring didn t classify these patients correctly. Out of 15 cotinine-positive patients, 5 (33%) were incorrectly classified as nonsmokers based on CO monitoring. Fig 8 Group 1 : 15 patients with a positive COT test Fig 5 CO-monitoring Fig 7 Follow-up consultation positive COT test non-smokers Fig 9 Smoking behaviour after LTX Fig 10 Cotinine test CONCLUSIONS Our study showed that 17.4% of formerly smoking lung transplant recipients continue to smoke. Only 13% of these patients reported themselves to be currently smoking. In our study, urine COT analysis seems to be more sensitive and specific when compared to CO monitoring to detect tobacco use. The positive predictive value of CO monitoring is too low (52%), making it not useful as a screening tool. HYPOTHESIS Systematic monitoring of urine cotinine levels is warranted in the follow-up of lung transplant patients who have a prior history of smoking.

22 Smoking cessation during hospital stay: nursing action and answers. Cathy Lodewijckx, ERS Munchen

23 BACKGROUND RESULTS (1) 60% 50% 40% 30% 20% 10% 29% 30% 24% 25% 21,9% Smoking cessation during hospital stay: nursing actions and answers C. Lodewijckx LN, G. Celis RN, A. Schoonis RN, J. De Bent RN, M. Peys RN, V. Lemaigre Psychologist, L. Van Houdenhove Psychologist, K. Nackaerts MD,PhD Hospitalisation, especially for tobacco-related illness: increases perceived vulnerability and boost receptivity to smoking cessation interventions brings smokers in contact with health carers who can AIMS provide To explore: a smoking cessation message or intervention need of smoking cessations intervention on respiratory wards nurses perceptions among smoking cessation interventions efficacy of nurse-delivered smoking cessation interventions Methods: multi-centre descriptive study Sample: n = 548 patients hospitalised on 12 Belgian respiratory wards between 17/10/05 31/10/05 Results: smokers: n = 117 (21,9%); ex-smokers: n = 261 (46,8%); never smokers: n = 170 (31,2%) 378 patients (68,7%) could use our help to quit smoking or stay abstinent 70% 67,44% not willing to quit 50% 45% 40% 35% 20% 15% 10% 15,5% 6,4% 46,8% 33,2% 16,85% 6,13% 13,6% 5,36% willing to quit no answer 31,2% quit smoking for 0-6 days Pneumology Division, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Belgium RESULTS (3)** quit smoking for 7-30 all patients days 18,6% quit smoking for 1-6 men months 12,6% quit smoking for 6 women months-1 year quit smoking for >1 year 4,21% 0% 5% 0% Smokers Ex-smokers smokers ex-smokers never-smokers Fig.1: Smoking status in 548 patients hospitalised on 12 respiratory Belgian wards (10 different hospitals) n=54 (14,5%) Fig. 2: Nurse-delivered smoking cessation intervention n=199 (53,5%) RESULTS (2)** Perceptions among smoking cessation interventions: hospitalisation is an ideal time for patients to quit smoking smoking cessation is an important part of the nursing role Mean reasons for NOT providing smoking cessation: patient-related: lack of motivation, privacy, condition nurse-related: lack of knowledge, lack of skills and confidence, lack of time Tobacco use among nurses: Fig. 3: Nursing smoking cessation congres 03/12/2005 Ostend Belgium prevalence: 7% - 46% perception of smokers in nurses among smoking cessation intervention: less enthusiastic less confidence in skills and efficacy Revie w Results Rigotti et al. (2003): meta-analyses of 29 studies; any type of health care setting Schultz et al. (2003): overview of 10 studies (6 RCT s); nurse-delivered hospital based interventions significantly increase of quitting with nursing intervention more intensive intervention is not significantly more successful patients seems to be more receptive for smoking cessation interventions during hospital stay Tabel 1: Effectiveness of nurse-delivered smoking cessation interventions CONCLUSIONS At least 25% of patients hospitalised on respiratory wards could use help in quitting smoking or staying abstinent Strong evidence for effectiveness of nurse-led smoking cessation intervention Nurses perceive smoking cessation as an important part of their role, but need more skills and knowledge CHALLENGES Integration of tobacco dependence treatment into standard nursing practice Nursing education among smoking cessation interventions Support for tobacco dependent nurses Support (financial, resources) from government and hospital management ** References available by the author: cathy.lodewijckx@uzleuven.be

24 Counselling for smoking cessation needed in one third of hospitalised respiratory patients Daniel Schuermans, ERS Munchen Eerste enquête BVPV-SBIP

25 ERS Travel Grant 2006

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27 Next year : Nursing assembly from COPD supported by BVPV-SBIP (ERS 2007 in Stockholm)

28 Munchen 5 sept 2006 Oprichting van een internationaal netwerk voor pneumologie verpleegkundigen Active REspiratory Nurse Area

29 Nursing communication platform (NCP) Wat? webbased platform voor respiratoire verpleegkundige verenigingen. Doel: samenwerking tss verpleegkundige respiratoire verenigingen wereldwijd

30 Global Nurse Network Nursing communication platform Prof. Antje Fink-Wagner Manager Professional Relations Respiratory Global Franchise Management, Medical Communications

31 Nursing Communication Platform

32 NAVORMINGSAVOND COPD: een zorgprogramma in COPD: een de lift zorgprogramma met een in de lift met een cruciale rol voor de verpleegkundige cruciale rol voor de verpleegkundige Waar? UZ Leuven (zaal BMW 6) navormingsavond Wanneer? Woensdag 15 november 2006 woensdag 15 november 2006

33 Specialisatieopleiding Pneumologie in UZ Leuven vanaf 11 januari lesdagen Van jan tot april 2007 Inschrijven kan bij Mieke Peys, hoofdverpleegkundige E652 UZ Leuven Tel 016/

34 Jaarcongres BVPV_SBIP Zuurstof: Beter Ademen? L Oxygène : Mieux Respirer?